Disagree with relaxing diabetes standards
I'm a registered dietitian and CDE who works in the outpatient setting of a large hospital, primarily in diabetes and weight management. I teach diabetes classes weekly and also counsel people on a 1:1 basis. Recommendations in our handouts and presentations generally fall in line with ADA guidelines, i.e., fasting BG of 70-130, postprandial BG <180 at 1-2 hours, and A1c 6-7%. I think most of these goals are too high, and I tell my patients to aim for postprandial readings <150 and an A1c of 6% or less in most cases in order to reduce their risk for complications. Although not everyone is able to achieve these goals, I believe it's important to strive for optimal glycemic control, if possible
At a recent department meeting, my supervisor told us that are standards are being relaxed, and that we should now consider an A1c of 7-8% as acceptable control. This equates to an average blood sugar level of 154-183 (other equations for A1c calculation would be even higher than this). I was completely floored. This wasn't my supervisor's decision; it came from someone at a higher level. As it was explained to me, the reason for this change is because many of our patients have multiple comorbidities and will be unable to achieve such "tight control." Well, 180 after meals with an A1c of 6-7% isn't really tight control in my book! And if one's average blood sugar is 183, then much of the time he or she is probably well into the 200s. That's just too high, plain and simple.
I was so upset when I heard about this. Telling people that they're doing well when their blood sugar levels are placing them at risk for retinopathy, nephropathy, neuropathy, cardiovascular disease, stroke, amputation, etc., is something I just can't do. I honestly love my job, my coworkers, and my patients, but I refuse to give people a false sense of security. Sure, some will continue to eat whatever they want and be lax with their meds regardless of what I say, but for those truly interested in preventing complications, I want to be there to advise and guide them on successful BG management. And, yes, I am a low to moderate carb advocate (35-120 grams per day; I personally do about 70-90), but I respect those who want to eat more carbs and am very happy to guide them in making better food choices, increasing exercise, timing and dosage of meds, etc.
I wanted you to know that there are dietitians out there who don't agree with ADA standards and certainly don't agree with relaxing them any further! BTW, I have been on this site for a while using my real name and have participated in a few threads. But I have also seen lots of posts that I wanted to comment on but didn't feel comfortable doing so in a public forum with my photo, name, and other identifiable information. I hope you can all understand this and realize that I'm doing my best to effect change in my facility on my own.
Sorry this is so long -- brevity was never my strong suit!
At a recent department meeting, my supervisor told us that are standards are being relaxed, and that we should now consider an A1c of 7-8% as acceptable control. This equates to an average blood sugar level of 154-183 (other equations for A1c calculation would be even higher than this). I was completely floored. This wasn't my supervisor's decision; it came from someone at a higher level. As it was explained to me, the reason for this change is because many of our patients have multiple comorbidities and will be unable to achieve such "tight control." Well, 180 after meals with an A1c of 6-7% isn't really tight control in my book! And if one's average blood sugar is 183, then much of the time he or she is probably well into the 200s. That's just too high, plain and simple.
I was so upset when I heard about this. Telling people that they're doing well when their blood sugar levels are placing them at risk for retinopathy, nephropathy, neuropathy, cardiovascular disease, stroke, amputation, etc., is something I just can't do. I honestly love my job, my coworkers, and my patients, but I refuse to give people a false sense of security. Sure, some will continue to eat whatever they want and be lax with their meds regardless of what I say, but for those truly interested in preventing complications, I want to be there to advise and guide them on successful BG management. And, yes, I am a low to moderate carb advocate (35-120 grams per day; I personally do about 70-90), but I respect those who want to eat more carbs and am very happy to guide them in making better food choices, increasing exercise, timing and dosage of meds, etc.
I wanted you to know that there are dietitians out there who don't agree with ADA standards and certainly don't agree with relaxing them any further! BTW, I have been on this site for a while using my real name and have participated in a few threads. But I have also seen lots of posts that I wanted to comment on but didn't feel comfortable doing so in a public forum with my photo, name, and other identifiable information. I hope you can all understand this and realize that I'm doing my best to effect change in my facility on my own.
Sorry this is so long -- brevity was never my strong suit!
Replies to This Discussion
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Permalink Reply by Peetie on -
Best of luck Kelly. Thanks for all the advice you have given to me. Thoughts and prayers going out to you too.
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Permalink Reply by Amy Cox Clouse on -
I'm a newbie and my D was triggered by steroids following a bad reaction to penicillin. Nothing about anything I've gone through has been typical in this journey so far. I did have some issues with my vision when my BG was around 489 for a nearly a month. Fortunately, there was not any permanent damage, but I'm certainly not making light of your situation.
I also have celiac disease, migraines, chronic atypical shingles and possibly lupus. Highs and lows tend to trigger headaches and bouts of shingles both of which I've been dealing with since I was 22. This disease sucks, but it's the first thing that the doctors have been able to tell me over which I could exercise ANY control. I don't eat wheat, I stay out of the sun, I now don't eat carbs. Migraines still raise my BG and so do shingles. I run a mile a day, but if I push too hard then it triggers one or the other.I take Neurontin daily for postherpetic neuralgia/nerve damage from celiac disease & topamax for migraine prevention. It's a balancing act. I didn't mean to offend or imply that it is the answer for everyone. I don't really have all that many options and I'm really trying to do the best I can with the cards I've been dealt.
Best wishes. . .
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Permalink Reply by jrtpup on -
I may be the odd (wo)man out, but I haven't seen anyone in any of these posts saying everyone should do what they do, or that there is only one way. What I hear is people sharing their experiences, what works for them. We are all different, nothing works for everyone.
One of the most useful things for me about TuD is hearing how others manage their D, with their individual issues and needs. Once in a while something tweaks a nerve for me and I try something new.
I did post when my A1C went from 8.4 to 5.9 in 3 months. It wasn't meant to lord it over anyone, it was simply sharing a success and my excitement about it. I feel badly that so many people are feeling put down and criticized.
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Permalink Reply by MossDog on -
95% of people's posts I do not interpret it to be demeaning or criticizing in any way. In fact, for me I can look past those 5% because I feel I am doing right FOR ME. See the common theme? Diabetes is a personal thing where for the most part you make you own personal goals and find a way to get there in your own personal way. I would just hope that 5% could help people in a way that is not critical or demeaning. DM is hard enough without it!
JRT you should be proud of that improvement. You should post about it. In fact you should scream it at the top of your lungs on the highest roof tops for the world to hear! TuD should be a place for everyone to share their struggles, failures, AND acheivements. I have not read ANYTHING you have posted as criticizing or demeaning. There is no reason, in my opinion, for you to be sorry about anything.
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Permalink Reply by jrtpup on
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Thanks MossDog. I'm not even sorry about the yummy chocolate croissant I treated myself to after leaving my endo's office with the new A1C :)
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Permalink Reply by jrtpup on
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Elitist? Nah, not me. Wild and crazy despite being 60, and plenty bitchy sometimes, but not elitist LOL
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Permalink Reply by Natalie ._c- on -
Well, if you're female, and you're a dog, how can you help being a bitch????? :-)
Me, I'm female, but I'm a cat, so I'm a queen, LOL!!!
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Permalink Reply by Natalie ._c- on
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Sure, I'm an elitist, but I'm not opposed to ANYONE joining the club! All you have to do is WANT to. And if you don't achieve perfection, well, I'll let you into a little secret -- neither do I! LOL!!
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Permalink Reply by Kelly WPA on -
the important thing is not whether or not you achieve, the important thing is that you try! I don't achieve it all the time either, but I try and I don't give up on the days that I don't make it.
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Permalink Reply by Low Carb Dietitian on -
Agree 100% with this, Moss Dog. And if anyone feels that I have been critical, demeaning, or condescending, I apologize, as that was not my intent in starting this discussion.
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Permalink Reply by jrtpup on
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It was clearly not your intent, and clearly (to me) not what you've done.
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