What do you think? looser control OK?

I just had my semi annual check up. Doc wants me to stop meds altogether, says I'm doing fine on diet and exercise alone. Said not need to take my Januvia except if I spike over 200. I've been taking it if my BG goes over 140, at 2hr post meals. She doesn't want me to go low (I've only gone low once this past two months and that was just 64, no adverse effects)as that will affect nutrition to the brain. For the record, which I showed her, I was high (over 140 2 hr post meals) twelve times in two months, but only four of those were due to overeating carbs. The others were due, as best as I can tell, that I need to get back on the meds because I was gradually drifting to higher and higher numbers.

I don't want to wait until I hit 200. I told her I prefer stricter control.
She hasn't cancelled my prescription, but it does worry me that she isn't worried about me having spikes under 200 mg/dl.

Please, guys, what is YOUR opinion? Thanks!!

Readings of 200 are not OK. Your goal of never going over 140 is a reasonable one and is also one you have been able to achieve in the past, with the help of medication. The bloodsugar101 website has a whole page of papers from peer reviewed journals supporting this view. This is also the standard of the American College of Endocrinologists. If you support your view with evidence, perhaps your doctor will relent.

I think her take on it is that I would be better off to do something else (exercise, postpone eating more for another hour) than take the meds. I have seen bloodsugar101 before and in fact that is where I got the idea to do strict control. I suspect she is viewing things from the standpoint of what she would need to change in managing my case rather than what I would need to do to prevent future complications.

At any rate, I certainly don't plan to let my numbers soar any higher. What I had been doing was eating less carbs until I was stuck at 140 even though I only had 20g of salad, then take the pill. And I want to keep doing it that way. I hate eating less than 20g for every meal; half the time, OK, all the time, no.

decide for yourself and read this


-Fasting blood sugar
According to continuous glucose monitoring studies of healthy people, a normal fasting blood sugar is 83 mg/dL or less. Many normal people have fasting blood sugar in the mid-to-high 70s.

While most doctors will tell you that anything under 100 mg/dL is normal, it’s not. In this study, people with FBG levels above 95 had more than 3x the risk of developing future diabetes than people with FBG levels below 90. This study showed progressively increasing risk of heart disease in men with FBG levels above 85 mg/dL, as compared to those with FBG levels of 81 mg/dL or lower.

What’s even more important to understand about FBG is that it’s the least sensitive marker for predicting future diabetes and heart disease. Several studies show that a “normal” FBG level in the mid-90s predicts diabetes diagnosed a decade later.

-A number of studies show that A1c levels below the diabetic range are associated with cardiovascular disease. This study showed that A1c levels lower than 5% had the lowest rates of cardiovascular disease (CVD) and that a 1% increase (to 6%) significantly increased CVD risk. Another study showed an even tighter correlation between A1c and CVD, indicating a linear increase in CVD as A1c rose above 4.6% – a level that corresponds to a fasting blood glucose of just 86 mg/dL. Finally, this study showed that the risk of heart disease in people without diabetes doubles for every percentage point increase above 4.6%

And last but not least? Have you tested any Non D Family members B4 and 1,2 and 3 hrs after Dinner..?

Now how you Get to stay in a Normal Range of btwn 80-110 as much as Possible, remains to be seen..

Maybe I should clarify. I already believe that 200 is not good and I know about the risks. Dennis and BadMoon, I'm glad you referred me to those articles and I have printed them, plan to show my doctor next time I see her. My concern is her attitude. I don't want to have to change doctors because she is also managing another condition I have that is not diabetes related. I hope this does not become an issue. I can only imagine what other patient scared her about lows that she doesn't want to see me ever being low, which is a bit ridiculous right now, how often would type II ever go seriously low, you know?

I think that we often don't always communicate our health goals to our doctors and I know that at times they don't listen. But I think, from what you say, your doctor does listen to you. And a reasonable goal is to keep your after meal blood sugars under 140 mg/dl. And as BadMoontT2 notes, that is the recommendation from the AACE , not just some suggestion on the internet. Although this is the guidance from the specialists, most doctors follow loose ADA guidelines. These guidelines suggest increasing medication when you "fail." In ADA land (not reality), that means your A1 > 7% and your after 2hr meal numbers > 200 mg/dl. Obviously, this is not acceptable.

That being said, going over 140 mg/dl once or twice a week is stil achieving your blood sugar goals more than 90% of the time. That is pretty darn good. So perhaps all you need to do is come to terms with your doctor, if your ability to achieve goals drops below 90%, you would like medication. A not unreasonable approach.

ps. I don't know if you have tried metformin, but metformin may also be a compromise.

pps. We all sometimes have those meals where all we had was a speck of lettuce and water and our blood sugar is "OMG." It is better to act on the average than the outlier.

Thanks, bsc, what you said is what I'm going to do.
The reason I'm on the most $$ med is that I'm one of the few that can't take metaformin due to the other condition I have. But it wouldn't surprise me if another doctor would think I could have it. World of medicine full of different opinions.

And I'd also like to offer you a final word of encouragement. You have done a great job with your diabetes. You need to pat yourself on the back. But you also need to place all your health risks in perspective. Januvia (or similar meds) will be of very small benefit to you as you already have good control. Sometimes, we just need to not obsess too much, celebrated our success and be satisfied with "not too shabby."

ps. At times, I really think I should also take my own advice.

Keeping track of how often we are within our target range is a point that I strongly believe in. It's one of those data points that I obessess over and track religeously. I've never achieved 90% within range over any extended time period because of combined highs and lows, but I do manage to stay under 140 close to 90% of the time.

I hate to keep harping on the standard deviation thing bsc, but your last point regarding the effect of outliers is exactly why I track my actual distribution and percentage of tests within range instead. It's not even so much the 20% of the time that I'm outside of my range as much as it is the 5% of the time I'm spiking high that throws my own standard deviation estimate of variation wayyyy off.

I can either super obessess about why I have such a high relative standard deviation or just obsesss over that 5% of the time Im super spiking. At the end of the day, all I can do is to try to take direct control over my spikes.