I was diagnosed type 1 in August, probably heard this type of story over and over. I guess everybody starts looking at complications right away. Are my feet going to fall off? Am I going to die much earlier than most? I guess I have been so worried about having my blood sugar high all the time that I end up walking around with low blood sugar, feel bad eat candy to reach normal level again, repeat.

I usually keep my blood sugar highest 6-7 but typically 5 down to the 4 range. How high is too high and how long before it does damage? I mean if we go like 1 hour at 10 mmol./l is it doing damage? When people say they have high blood sugar is that like weeks at a time and how does that happen if we are taking insulin? Just eating the wrong food? Now I feel scared of food and try to avoid carbs all together especially if I'm going over to a friends house to eat and all they are serving is white bread sandwiches chips and soda. Do you just say screw it, take a shot and go for it? Am I being overly paranoid? Thanks for any feed back.

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I was 23 when I was diagnosed. I was just outta college and burnin' the candle at all ends; livin' like there was no tomorrow; playing in rock bands and therefore had a really erratic schedule; I didn't have any health-consciousness whatsoever; I ate whatever was laying around; I'd been an athlete as a high schooler, but was worn out by all that and had lost all interest in keeping my body tuned up and had stopped exercising. But, I was always skinny (funny how that ended up being a telltale sign after all...).

Any A1c below 7 is considered 'good' by medical professionals. My doc has his doubts about A1cs below 6 -- he feels that you must experience far too many hypo lows to be down in that range. And I agree with him. Of course, as I have said before here in other threads so it is starting to sound like a broken record at this point -- we are all wired a bit differently -- so some here are certainly able to withstand what hypos do to them more than me. I just hate the feeling of being 'down there,' so I choose to ride further up the scale so I don't feel that way.

Damage happens over years, not hours.

DX'ed -- January 15, 1982
No complications (lucky?... mebbe...)

/\/\

THat's amazing for a T1...any tips you want to share ?

Do you use any special diet to make things easier ? Do you use a CGM ?

How do you keep the variability low enough to avoid hypos ?

I started with a new doctor, recently, Alan and I'd done a home A1C and shared with him my latest A1C which is 5.7. I was pleased with his response: He did sound surprised but complemented me. If he'd lectured me about it being too low he would have failed a test in my mind. Though I've moved to a rural area with few (good) options for doctors, so I might have just had to "educate him" (nicely of course).

>> I recommend finding a Doctor that believes the ideal A1c is exactly the one you happen to have.

Yeah. Interesting thought. The long-lived ADA standard is anything below 7% is considered 'on target'. Glad to hear you don't have any hypos. That's amazing, Alan!

/\/\

zip,

THe left hand axis is relative risk...1 means no more risk than nondiabetics, 2 means 2 x the risk.

TO give you another data point, my endocrinologist says an A1C of 7% corresponds to a complication rate of 1 in 100 patient-years.

As has been mentioned above, these are averages over large populations and individual responses will vary. Many people who are Joslin medal winners (have had diabetes for 50 years) have no complications.

Hypoglycemia is not risk free either. Severe hypoglycemia can cause brain damage as the brain is starved of fuel....so the people that are so paranoid about complications they pass out frequently are damaging themselves in other ways.

The advice you have gotten above is good...the objective is good control while avoiding severe hypoglycemia and living an enjoyable life. Control diabetes, don't let it control you.

I like to think of an analogy to cigarette smoking and lung cancer. There is a relationship to the quantity and time that one smokes, but no magic formula for a precise prediction. I think that is what the graph is trying to show with A1C, and shows 'relative' increase in risk.

I've had T1 since 1965, and the first 20 years on 1 shot/day and no BG testing. A1C was probably 12-15+ the whole time. That was before the DCCT study. I do have complications with my eyes, that needed treatment after 23 years, ironically just after I switched to MDI and lowered my A1Cs. But other than that, complication free. As others have said, everyone is different, and many other factors besides just BG/A1C impact risk of complications. So best advice, do the best you can, without going too low, and enjoy a good quality of life.

I tried the Bernstein diet as well, and that diet sucks, really. I'd rather eat good food and really small portions, That guy says the only thing you can eat is cabbage, meat, and eggs. There has got to be a way to eat that's more exciting than that.

You guys ever eat white flour or is that just the worst? I noticed that white rice isn't as bad and potatoes are a good filler without sending the blood sugar to high. I eat oats for breakfast, but perhaps you guys know of something to fill you up in the morning that won't send the ol blood sugar through the roof. Oats in musli don't seem too bad though. any thought

Lot's of people on Bernstein on this forum. There's a big Bernstein group and if you are trying to eat low-carb like you say in your OP, check out the group.

http://www.tudiabetes.org/group/drbernstein

You'll see that it isn't just cabbage, meat, and eggs. =P

To answer your question, I'm not even on waht most would consider a low-carb diet and I really try to limit white rice, potatos, and white flour. They all spike my BGs to hell and any differences between them are marginal.

Hi zip, one reason why u maybe able to eat a lot of these higher carb foods like rice and potatoes is as a newly diagnosed type 1 diabetic you maybe going through what is called a honeymoon period. This essentially means that after starting insulin therapy, your pancreas temporarily recovers a bit, and is able to produce "some" insulin. This honeymoon phase is a very common thing most Type 1's experience, unfortunately over time though, the pancreas does give out and foods like rice, potatoes etc do tend to cause a much higher spike.

That being said, I do tend to watch my carbs however Im not ultra low carb, I try to average between 30 and 40 grams of carbs a meal and for me that works very well. I don't totally eliminate things like potatoes and rice, but I do tend to limit them in my diet and when I do eat them eat a very small amount. A small order of french fries if Im getting a hamburger. The smaller you can keep your total carb intake, the smaller the amount of insulin required to cover that food and the less chances of mistakes and lows...I am a firm believer when Dr Bernstein says that.

Everyone's diabetes is totally different and over time, especially as this honeymoon period wears off, you will really get a better idea of what foods you can eat, what your carb threshold is etc. I too eat for breakfast a lot of times certain cereals and oatmeal, however if Im running a bit higher in the AM I usually will pass on that and have some eggs instead. For me I usually range between 80-110 in the mornings now. As long as Im in that range I will have my cereal. Also certain cereals I have noticed for me I am able to handle better than others. I tend to eat a lot of the Koshi cereal, versus more higly processed cereals.

Good luck with your management, like everyone has said on here there are going to be days you are going to run a bit high, the key to good management is minimizing those high days, and the amount of time you stay high. A good rule of thumb is after eating...2 hours later your bg SHOULD be 130-140 AND coming down. Try to minimize those real dangerous spikes in your bg. If you are at 2 hours after eating say 180, then you might want to consider less carbs, or a different I/C ratio, or reviewing what you ate and the insulin you took to cover it and see where any miscalculations took place, etc. There is a lot of data that goes into good management but over time it really does become a part of your life. And as others have said on here, frequent lows can be just as dangerous as frequently running high. Try to shoot for that good middle ground.

thanks for the reply. It's finally nice to have some people that understand this stuff. My docotr is like just eat what you want as long as you keep your BG low. I live in Denmark so everything is all potatoes and bread and the doctors seem to think that's fine. I've discussed the Bernstein diet with him. He hasn't read the book and says that there is no science behind it, which is not true.

You are probably right on the honeymoon thing. I'm still producing a little insulin, but not enough to make a huge difference says the doc. Does metabolism have anything to do with BG? Some people gain weight faster than others I was curious if a person with a slow metabolism reacts different to insulin than somebody with a fast matabolism?

Hey Alan, glad to see you doing so well these days. Are you back on MDI?

Anway, yeah, no doubt, the EDIC follow-up to the DCCT shows that even if you fall off of your control and see your A1cs go back up, you're still at a lower risk for complications than those who never had tight control to start with. I wouldn't use that as carte blanche to "go for it" either, but is is encouraging regarding those periods of time when control just doesn't seem to be there.

I'm busting my keister trying to control spikes and keep those periods to a minimum and it's good to look at those times when we succeed as money in the bank.

Is getting rid of your glasses a recent thing? I know you've had great BG control for ahwile now and if you are still having breakthroughs like that, it's very encouraging.

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