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Permalink Reply by Jenny on August 19, 2007 at 2:17pm

The time spent high matters and there's a bunch of evidence that it is time spent high that does the damage.

When you are high, glucose flows into certain kinds of cells that don't need insulin to accept glucose--nerves and retina for example and damages them. So if you want to keep your nerves and retinas normal, you really need to keep your spikes as low as possible and as brief as possible.

You can get the same A1c with very different blood sugar patterns and the actual pattern probably tells you more about how your health will work out.

So the average isn't a good measure for health. The studies look at AVERAGES over large groups, and on average the GROUP of people with one average do better than those with another, but there are always people in that group with the one average who do very well and those who do very poorly, and it was adding up their blood sugar values and averaging them gives you the average for the group that is helpful to the researcher but not to the poor schnucks who did poorly.

When they look at people with diabetic complications and look at their glucose tolerance test blood sugar levels, it looks like the post-challenge (i.e. post meal) levels at which complications start is when blood sugars is still over 140 mg/dl at 2 hours after. That doesn't mean that everyone who goes over that level will get them, only that if you stay under 140 mg/dl at 2 hours you have much much less chance of complications. After that it depends on your own personal genetic make-up and luck if you are one of ones that do or one that doesn't get complications. There are people who are high for many years and stay fine but there are people with "pre-diabetes" who develop "diabetic" retinopathy. I like the idea of not counting on luck, so I try to stay under 140, though naturally I don't manage it all the time.

People forget that the 7% A1c in the DCCT trials lowered the incidence of retinopathy, but a significant percentage of people with Type 1 who had that A1c still got it. With type 2s, another study, UKPDS showed that the 7% A1c made a much smaller difference and a huge number of the Type 2s with the 7% a1cs developed retinopathy.

Doctors like averages because they don't have to look at your logs and talk to you but can give you one test and imagine they know all about your blood sugar. Easy for them, and they get to see more patients in an hour and make more money. Kind of hard on you if you go blind!

My web site at http://www.phlaunt.com/diabetes "What they don't tell you about diabetes" has a link to all the research I have hunted up over the years connecting organ damage and blood sugar levels. Hope it helps!

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Permalink Reply by Sherrie E on August 19, 2007 at 9:57pm

Thank you for all that information! I get upset with high numbers and didn't know if I should just be concerned about the averages. So, now I know. I should be concerned about the high numbers.

So far, I've been dealing with fasting sugars but I think I need to take a look at the 2 hours after readings. I know I'm above 140 on those many times. I never get the answers I need from the doctor. So, I really appreciate everyone online sharing what they've learned. Thanks, again!

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Permalink Reply by Jenny on August 20, 2007 at 7:07am

Sherrie,

The only training most doctors get about diabetes is an hour or two in med school followed by treating patients in the hospital who are way out of control. Unless they have a personal interest in Diabetes, they may still be going with what they learned in 1985! And because they have been telling people that any A1c under 10% is "good control" they figure all people with TYpe 2 deteriorate (as their patients with those high A1cs do!) so why nag you about doing stuff you probably won't do.

If you read the newsletters intended for practicing physicians, as I do, you'll also see that 99% of the articles considered important for them are just press releases touting the latest expensive drug. They don't have the time to read research and frankly, diabetes isn't very interesting compared to many of the other conditions they treat.

I was very fortunate to finally get a doctor who did read research, who put me on insulin while my A1c was in the low 6% range because he knew I was only eating 60-80 grams of carb a day and agreed with me that going over 140 mg/dl eating 8 grams of carbs was NOT a good sign. But my other doctors, including an endo looked at the A1c and said, "You're doing great come back when your A1c is 8%!"

By that time, i figured I'd have neuropathy and all the other "pathies" to say nothing of mostly dead beta cells, instead of the ones hanging in by their fingernails I still retained.

But the great part about getting aggressive early is that based on my response now after using meal time insulin for almost 2 years, if I eat a low carb meal without insulin, my beta cells are doing MUCH better now than they were 2 years ago--no more 140s with 8 grams! And it is SO much easier to use insulin when you still have some residual beta cell response to clean up what the insulin doesn't!

Do check out http://alt-support-diabetes.org/newlydiagnosed.htm I have heard from hundreds of people who have used the combination of diet and careful testing approach described there dropped their A1cs from as high as 13% down to the 5%s.

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Permalink Reply by DeeVa KC on September 2, 2007 at 10:19am

I have to agree with Jenny - It's watching those highs on a daily basis and working for low blood sugar's that is important. I gott a lot of hhelp off her website and from Dr. Bernstein's excellent book. I freaquently get sugars now in the 90's! And if I see on above 120 - I freak out & retest, try and figure out what I ate & where I went wrong - do a control test, whatever it takes. I do NOT want diabetic complications, so I'm doing everything I can to keep my sugars as normal as I can!

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Permalink Reply by Sherrie E on September 2, 2007 at 6:33pm

Wish I could get my doctor to realize that spikes matter. How in the world she can tell me "they look good" when I had numbers between 140 and 160 5 times within 5 days is beyond me. Maybe she gets an award for not prescribing medications.

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Permalink Reply by Gerry on July 8, 2009 at 10:15am

FASCINATING readings on your website. Thanks for putting it all together! I keep an A1C of 6.0 - 6.4, but my post prandial readings are significantly over 140. I need to rethink my nutritional plans. Thanks again!

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Permalink Reply by john stewart on August 31, 2009 at 11:40am

Were I live they have a good support group, and a nurse,dietitian,and various support

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Permalink Reply by Jan on September 3, 2007 at 6:45pm

Thank you for your honesty and knowledge. I am definitely going to look for your postings regarding diet as I may be able to learn and apply some of that knowlege to bring down my nieces ridiculous -- truly -- postprandial highs. We are now prebolusing and of course we adjust ICR and basals but as a Type 1 Juvenile Diabetic, she can get extremely high after eating. We then give more insulin for the food, but sometimes she responds well to the insulin, other times she still spikes. I have a call in to the endo to see if we should reduce carbs per meal and space out the meals more. But you are very knowledgeable and although her diet will be high carb because she is growing, I will try to learn and apply what I can. Of course I will have to check with her endo but I'm open to suggestion. We are getting a continuous monitor for her and one of the first things I will do is feed her and log the results of different foods so at least I can mix and match better. Our guidelines are to somehow get her to 180 two hours post prandial and I can't usually do that. I have at times, not always.

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Permalink Reply by Hana Rous on July 9, 2009 at 8:55am

It's not necessary for a teen to have carbs, even if growing. Look out for writings by Katharine Morrison, a Scottish doctor, who has broughtt her son through his teens on low carb. He's a very fit healthy young man.

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Permalink Reply by Rob on August 3, 2008 at 3:55pm

Thank you for taking the time to give such a complete answer. I am a newly diagnosed type 2 and found your answer to actually answer a few questions that I have.
Thank you.

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Permalink Reply by Maria on November 24, 2008 at 8:30am

Thank you so very much.... I've been "bad" about getting 2 hour readings.. I normally do the fasting and that's it.
I've also been "bad" about diet and exercise. My mom died of going into diabetic acoma, because of her bad eye site she gave herself too much insulin..... You would think I should "behave"

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Permalink Reply by Sophie on January 21, 2009 at 5:23pm

Hi Jenny,
I have been trying to figure all this stuff out--my endocrinologist prescribed Byetta and a blood glucose meter, and when I asked her how often I was supposed to test my blood (she didn't volunteer the information), she said, "Oh, in the morning and at night." From what I've been reading, that's not very helpful. I've been doing the after-meal testing.

But I'm still confused. Sometimes my blood sugar seems so odd and random. I'll have a few days or a week where it's normal in the mornings (in the 90s) or at least not too abnormal (100s but under 110), but then other days where it's in the borderline range, and just in the last few days I've been having these scary spikes where it has been 121, 125 and even 130 in the morning, and now I'm freaking out that my body is somehow going haywire. I thought it might be related to having a snack before bed, so I tried NOT eating for at least 4 hours before bed, and when I tested around midnight it was 92--but then when I woke up around 8 am, it had gone to 121!! I'm not eating in my sleep, so what's going on? And what can I do about it, since it's clearly not related to food?

I have also found that when my blood sugar is in the 'good' range--like 75-88--it tends to be when I haven't eaten for a long time and I'm starving. Do I have to constantly starve myself to be normal? I've been seeing a nutritionist, but she doesn't seem to know a whole lot about blood sugar specifically. You seem to have done a lot of self-education, and I'm wondering if you can recommend any books or web sources.

Thanks!

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