Firstly, I'm in England, so subject to the vagaries of The NHS[National Health Service] and NICE[ National Institute of Health and Clinical Excellence!]
We also have the advice of Diabetes UK[ our national diabetes charity]of which I'm a member.
I have a major beef with all of them. TARGETS!!!!
Blood glucose levels and Hba1c levels.
WHY are these so High?
To me it only makes sense that diabetics aim for NORMAL blood sugars[as Bernstein says, we have the right to normal blood sugars]
the targets set by the medical profession are much higher than that. some are double. A normal A1c is around [or below] 5%} so why a 7% target? and non diabetic blood glucose rarely deviates far or for long from around or just below 5mmol/l [90mg/dl]
Especially in the US where a 7% A1c in a new patient allows for a diagnosis of diabetes.
I accept that not everyone can hit the normal levels, but if you were at an archery competition, You wouldn't move the targets to where nearly everyone could hit them.
You would accept the target and work to improve your aim.
That's where I think the Healthcare profession is letting the patients down.
the only reasons for these unhealthy tarets that I can find are to do with protecting the medical profession.
Thus if patients hit the targets as set, and still develop complications, it's bad luck or the normal pattern of the disease. It can't be blamed on their healthcare team.
I do loads of voluntary work and recently at a meeting, I challenged a representative of NICE on this point. He agreed with me. Maybe we'll get somewhere???
My main quarrel with these targets, is not that lots of people can't or won't hit them[over 50% DO NOT in my area], but that loads of people who do, think they are protecting themselves from developing complications. So many who could get nearer to normal levels, don't because they don't know what they are.
Even many Healthcare professionals don't know what they are.
I know that I'm the ONLY patient of my health centre who consistently gets HbA1c results in the 5% range.[of hundreds perhaps a couple of thousand] My nurse says it's patients' choice. It's not if they Don't KNOW. So much for informed consent to treatment.
At an event I attended recently, I met a man diagnosed diabetic[T2} 15 years who is losing his sight and has suffered an amputation of a great toe. His Hba1c have been consistently wihin the targets.
It's these targets too which convince many doctors and diabetic specialist nurses that T2 is inevitably progressive.
Since at an HbA1c of 6.5% it's uncontrolled and uncontrolled diabetes is definitely progressive, they are right. However I'm certain that if diabetes is controlled[and it is possible] it does not need to progress.
Another target I hate ios 4mmol/l [72mg/dl] as a dangerous hypo. Most people can function perfectly well at that level, provided their system isn't used to "running high".
Thus a reading at this level to my mind doesn't need teating unless insulin is still in the process of driving it down. Danger level is much lower, probably below 3  The hypo number and the focus on the danger of hypos takes away attention from the much more common danger of consistently HIGH blood glucose. I have tried to find figures for deaths from hypos, but have failed. I know they are an unpleasant experience, but not nearly as dangerous as some people think.Most hypos are mild and easily corrected.
This is a case where the treatment is the problem not the disease itself.
However deaths from kidney failure or the after effects of amputations are big numbers.
Very true, acidrock. Doctors (& the ADA) are a barrier, regarding targets & patient education. Having received enough arrogance, apathy & misinformation from endos & a CDE, I nicely stated my goals to the last endo & asked if he could help me reach them. He kind of sputtered & turned the question on me by asking why those were my goals. Well, duh, because I'd like to avoid complications. I'm now going to my PCP for diabetes care. His son was recently diagnosed T1 & he's reading everything.
Carb 101's daughter Clara's A1c's (from her home page). Clara is almost 11 years old.
I totally hear where you are coming from! All it takes to push me past a PP 140 is 15g of carb. I once even hit 180 PP after a small zero carb meal. I feel so dispirited when I read the advice of diabetes writers I otherwise trust, saying you should *never* go above 140. For me, that's virtually impossible and unrealistic. And nobody seems able to tell me if I'm doing harm to myself with these excursions (it always comes back down again 4-5 hours later) even though my overall A1C is ok.
I don't think anyone really knows the answer to that. However, I do know that glycation of hemoglobin takes several hours, and is partially reversible. So if a peak is short-lived, then it shouldn't contribute much if anything to glycation. However, I don't know if that applies to other tissues or not.
I forgot -- are you on insulin? I also experience 2-hour peaks higher than 140 (usually 160-200) when I consume even a small amount of carbs, but I'm on insulin, and they come down within 4 hours. If your excursion is lasting that long, maybe you need insulin?
Hi Natalie, yes I am on insulin. My Novorapid does absolutely nothing in the first 2 hours. But I am usually back to a normal range 5 hours after insulin. I have tried injecting earlier and that works some of the time; however sometimes that gives me hypos.It also isn't always possible to inject 2 hours before eating - plus it makes carb counting even more difficult.
I brought up this issue at my last meeting with the diabetes nurse and they are so terrified about people getting hypos. Their official advice is not even to test after meals 'because of course it'll be high' but only to test before the next meal and do the adjustment then. This makes sense as it would be 5 hours later in most cases - I have had pretty nasty hypos from insulin stacking up.
Ok, you didn't hear this from me and you are not advised to do this, but intramuscular insulin injection can improve the rapidity of insulin action. Here is Dr. B on the technique although he advocates it for correction Dr. B on Intramuscular Injections. There is potentially more variability in action (http://care.diabetesjournals.org/content/11/1/41.short). Oh, and you didn't hear it from me.
Another old trick of mine was to take the R in my leg and run up and down the stairs 10x, particularly on Thanksgiving!
R does absorb more quickly if the body part it was injected in is exercised. However, I'm pretty sure this is not true of the newer analogues. Something about the way they are modified so that it's essentially impossible for them to "break down" faster than they already do (aside from injecting it IM or IV).