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!