My blood sugars are pretty good but I don’t really know whats good enough.They have probably risen above 200 once this year, is this good? or is between 140 and 200 still considered to do damage regardless of rising above 200?
The goal is to keep your sugars under 160-180 in a two hour period. If it is higher in that two hour period, you must do a correction to avoid cell/organ damage.
Yogi
There’s no magic number below which we’re guaranteed safe from complications. Look at the DCCT or UKPDS results; there is no A1C or bg below which diabetics do not suffer from microvascular complications. Others on the web might push some magic number, but really it doesn’t exist. What is clear, is that keeping average bg as low as safely possible (DCCT says a lot about hypo risks at average bg’s get lower) does help reduce the risks.
I agree Tim. I believe genetics is what makes it hard to pick an exact number. Some people will be free of complications with consistent a1c’s at 7% while another will progressively get more and more complications at that same a1c. What CAN be said is that at certain numbers these risks are reduced for the population as a whole but this does not necessarily apply to the individual.
With the qualifications above, we all set our targets differently. I aim for under 140 2 hours after meals, others aim for 120 and others even lower to mimic the healthy pancreas. Imho staying “under 200” is not an adequate goal, although when people are first diagnosed they often lower their goals slowly. Fore instance if all your blood sugars are over 200 and into the 300s and 400s when diagnosed, then keeping it “under 200” would be a good first step.
That’s great that you were only over 200 one time in a year! I wish I could say that! Because no matter how much we set goals, and do everything we know how to meet them, sometimes the “diabetes gods” have other ideas. One out of target number, though is not grounds to freak out, especially if you correct and get the number down as quickly as possible. It is the consistently high numbers over time that can lead to complications. As the others have said, there are no guarantees so you set your goals as low as you can live with, and do your best to meet those targets as much of the time as possible.
So should the ADA stop recommending 180 and under after 2 hours? However, I do think it depends on someone’s life style. I do like my sugars @ 180 just before exercise, so that I have plenty of cushen when it drops.
There are a lot of people who think they should lower their 2 hour post meal numbers as well as their A1c goal. I read a response from the director of the ADA when there was a big debate about this. His argument was that for the most part people don’t even reach the goals they have stated so it is kind of a pointless debate. My personal opinion is that there are a good deal of people out there that would work harder at reaching more stringent numbers if that was there posted goals. So yes, I think they should change this.
I think given the american lifestyle (in general), and the fact that not everyone has the kind of job were you can bring your own food etc., Haveing a blood sugar of 180 after 2 hours is resonable, and more achievable for the average diabetic.
My problem with this is that, if you have JUST been diagnosed, those kind of numbers would be overwhelming (I think). Changing the recommended glucose levels can cause diabetics to over use insulin; and the possiblility of more diabetics having hypoglemic episodes.
Yogi
I absolutely agree with MossDog that the ADA should lower their targets. I find the argument that “most people don’t even reach those goals” a very sad response. People trust their doctors and if the doctor says “under 200 is ok” or “under 180 should be your goal” that is all many people will achieve.
I think it is reasonable to do what many doctors do and say to the newly diagnosed person, "let’s start (for example) with getting your numbers that have been (for example) from 200-400 consistently down under 200 and then we will work on tighter goals down the road. My experience has been if you don’t expect much from people that is what you get. If you (gently) encourage people to do better, then they will!
don’t you think that’s a seperate arguement though? One is not even an arguement, it is a straight up insult to all diabetics, to assume that none of us don’t or can’t reach our goals. The second is lowing blood sugar guidelines.
From personal experience, i’ve seen a LOT of doctors, and there were a lot of things that they should have told me, and failed to do so. I have learned more about diabetes though sites like tudiabetes and reading books, then I ever got from all my doctors put together.
Therefore, I do think it should stay that way, so that the patients that don’t know better to ask, Or have crappy doctors, they can have some kind of goal to strive for, withought being overwhelmed being newely diagnosed.
Yogi
absolutely.
I totally agree with MossDog on this. To me, it seems like diabetes is a struggle whether you have a goal of tighter control or not so you might as well try to run tighter. Even if you don’t succeed 100% of the time, you can get the data that you need to make incremental progress towards your goal, expand your knowledge of food, your body, insulin, exercise and other factors that can impact your BG. Then, when you have it all figured out, your body will change with age, since it will probably take a couple of years, and then you are back to the drawing board, with another set of challenges as your job changes or life changes or whatever. My assumption for a long time was that I wasn’t likely to last much past 40 but now, @ 43, I am sort of into some gravy but stuff like retirement is within striking distance? heh heh heh…
I think those two things SHOULD be separate arguments, but unfortunately I think they are very intertwined in the minds of the larger medical community (not all practitioners of course), the AMA, ADA and all those other financially driven acronyms. When the profit margin is the primary motivator (whether anyone would admit to it or not), then the philosphy becomes not the well-being of all, and certainly not striving to call people to a higher standard, but “hedging your bets”, deciding what the least amount of effort (expense) will give the greatest amount of result (profit) and letting the rest go by the wayside. So if popular opinion is that most Americans are obese, disease prone and strongly attached to a fast food sedentary way of life, then lip service might be given to improving health, but in reality lowered expectations becomes the norm.
So if a doctor in an HMO is given 18 minutes per patient (I believe the actual average is less than this?) he takes a look at Joe average’s beer belly, 12.0 A1C and hands him a script, tells him to test in the AM and stay under 180, eat by the pyramid and moves on.
These are, of course exaggerations and generalizations but yes, I am cynical enough to think they are the rule not the exception.
Yeah, I see your point… This is very true… And unfortunate…
Yogi
That’s a broad question. Will keeping it under 200 prevent complications? Maybe. But the lower (within reason) the better.
Keeping it 99 would be better than keeping it at 199. They’re both under 200, but there’s a vast difference.
I think too that it doesn’t guarantee it will prevent complications but your odds are a lot better?