A1C cut-point to avoid diabetic complications

[finsit]

Not true.

Agree.
And the same goes for T2's on insulin.

Hi thanks for your input. Probably i put it wrongly that "hypos will only happen on high carb/high insulin diet", what i meant was that i came across several studies and it seems that on low carb diet people with T1 DM will experience less hypo events than on high carb, so that is my correction. If anyone interested to read more about this study, i have one that i can quote here but there are several others online, just need some digging.

https://pubmed.ncbi.nlm.nih.gov/30924570/

This is the summary here of the above link

Abstract
Aims: To compare the effects of a low carbohydrate diet (LCD < 100 g carbohydrate/d) and a high carbohydrate diet (HCD > 250 g carbohydrate/d) on glycaemic control and cardiovascular risk factors in adults with type 1 diabetes.

Materials and methods: In a randomized crossover study with two 12-week intervention arms separated by a 12-week washout, 14 participants using sensor-augmented insulin pumps were included. Individual meal plans meeting the carbohydrate criteria were made for each study participant. Actual carbohydrate intake was entered into the insulin pumps throughout the study.

Results: Ten participants completed the study. Daily carbohydrate intake during the two intervention periods was (mean ± standard deviation) 98 ± 11 g and 246 ± 34 g, respectively. Time spent in the range 3.9-10.0 mmol/L (primary outcome) did not differ between groups (LCD 68.6 ± 8.9% vs. HCD 65.3 ± 6.5%, P = 0.316). However, time spent <3.9 mmol/L was less (1.9 vs. 3.6%, P < 0.001) and glycaemic variability (assessed by coefficient of variation) was lower (32.7 vs. 37.5%, P = 0.013) during LCD. No events of severe hypoglycaemia were reported. Participants lost 2.0 ± 2.1 kg during LCD and gained 2.6 ± 1.8 kg during HCD (P = 0.001). No other cardiovascular risk factors, including fasting levels of lipids and inflammatory markers, were significantly affected.

Conclusions: Compared with an intake of 250 g of carbohydrate per day, restriction of carbohydrate intake to 100 g per day in adults with type 1 diabetes reduced time spent in hypoglycaemia, glycaemic variability and weight with no effect on cardiovascular risk factors.

 

[OrsonKartt]

4/

I would be very interested to hear more about your personal experiences with your glycaemic control, number of years of diabetes and any complications that developed or reversed.[/QUOTE]

Hi , i'm responding here not as a direct answer to your question but as an observation. I recognise your research as being something akin to my response to being diagnosed. In my case I went as far as doing an open university course in diabetes to find out what the hell is happening .... I also started a daily N=1 diary, noting every scrap of food /drink and anything which may affect my personal daily blood sugar readings including the weather! . After more than 4 years this personal data taken numerous times each day is of some value to me and sometimes I begin to think I have it understood. Other days its not so clear. I'd recommend it as it gives a small insight into how complex our situation is.

 

[finsit]

This is one of the most recent research studies that was done in 2020 on a fairly large number of patients related to time in range (70-180 mg/dl) and diabetic complications. Very useful information.

https://www.hindawi.com/journals/ije/2020/8879085/

 

[finsit]

4/

I would be very interested to hear more about your personal experiences with your glycaemic control, number of years of diabetes and any complications that developed or reversed.

Hi , i'm responding here not as a direct answer to your question but as an observation. I recognise your research as being something akin to my response to being diagnosed. In my case I went as far as doing an open university course in diabetes to find out what the hell is happening .... I also started a daily N=1 diary, noting every scrap of food /drink and anything which may affect my personal daily blood sugar readings including the weather! . After more than 4 years this personal data taken numerous times each day is of some value to me and sometimes I begin to think I have it understood. Other days its not so clear. I'd recommend it as it gives a small insight into how complex our situation is.[/QUOTE]
Thank you It seems a lot of effort for so many year, well done. I would be very much interested to see the results of your experiences and variations if possible at all ?

 

[Rokaab]

Thank you for sharing your personal experience and definitely two thumbs up for keeping it at 6.3% after all these years..

I think you read it wrong after 40 years I have only just managed to get it down to 6.3, before a couple of years ago (ie when I got the libre) it was never even close to that.

Though one thing I will say is that basically no matter how much research you do, if you are not a T1 you will just not understand how much effort it takes and how unpredictable it can be

 

[finsit]

I think you read it wrong after 40 years I have only just managed to get it down to 6.3, before a couple of years ago (ie when I got the libre) it was never even close to that.

Though one thing I will say is that basically no matter how much research you do, if you are not a T1 you will just not understand how much effort it takes and how unpredictable it can be

Sorry i meant to bringing it down to 6.3% after all these years of high a1c. I suppose uncontrolled older diabetes is harder to manage. Wish you all the best.

 

[finsit]

Sorry to hear you have been diagnosed with diabetes, I remember that it was a shock to my system but I learnt to live with it.

I was diagnosed in 2010, I can't remember what level my a1c was but it was bad, off the shart and I think the shart that the DN uses goes up to 100.

I was put on one metformin SL 500 and attended a diabetes seminar once a week for a month. I changed my diet, lost 10kg and substantially increased my exercise routine in that month; for the next 6 months more of the same. The next a1c was normal and I was taken off the tablet.

I made the mistake to relax my diet and incorporate bread, pasta and rice to normal quantities, having said that, my a1c for the following 4 years was in the green zone or < 48

On the 5th year I was diagnosed with Atrial Fibrillation, doctors couldn't tell me how long I've had it since I don't get any symptoms so it's possible that I had it before diabetes, never stopped me from putting my body through intensive training. Doctors said I had to change my exercise routine.... basically slow down my cycling drastically, for some reason cycling with an eye on my heart rate became boring and I couldn't motivate myself to go out as much, diabetes came back soon after and since then I piled on the weight and the tablets. During the first lock down I lost 4kg and I thought I was doing really well, apart from feeling very tired all the time, I blame the lockdown and the lack of activities.... every Saturday I was out with my cycling club doing in excess of 50 miles, before the lockdown... in August 2020 I was invited for a blood test and my a1c came back at at 135 or 14.5 in American money. I was already on 4 metformin so the DN added 2 glicazide 80mg. After a month or so I began to look for an alternative treatment or something else to add that could make a difference.... I had listened to the advice and I was adding more tablets every year. I found videos on low carb and intermittent fasting on youtube and began to try out some of the advice, I had nothing to lose, after a week I was doing OMAD and dropping a tablet per week, after 6 weeks I had lost 14kg and I was free of tables for many years.... my energy levels were back to normal so I started doing a lot of work around the house and cycling which helped with the weight loss. In December 3rd I has my last a1c and it was 47 and it should be lower now.

That's my life as a diabetic type 2, you can reverse diabetes following the correct advice.
I'm not sure my Atrial Fibrillation was caused by the diabetes, it's possible though. My eyes are OK but my kidneys are suffering with the diabetes... I have to take tablets to protect them. My libido has never been a problem, not even when my sugar level was so high.... although my eyes took a pounding then, I was worried that my vision became blurry but it's back to normal now and the eye test for diabetics didn't pick any damage.

I wish someone told me years ago that the cause of my diabetes was insulin resistance and that snacking made the problem worse.... I never saw anything wrong with picking a few grapes, an apple, a biscuit, etc throughout the day since I was a child, my snacks weren't large but were many and every time I snacked my pancreas released more insuline until I became insulin resistant.... too many years of abuse.

Low carb diet and intermittent fasting is my new way of life now, I got used to it.

I hope that helps but if I were you I wouldn't worry too much about what complications you might get in the future, simply try to learn how to keep your glucose level in the green zone.

Good luck

That sounds like a typical cycle of diabetics. Yes, you pointed it right, insulin resistance is the culprit, but may I ask does DM runs in your family as well ? I see you had a huge improvement and coming off meds from 135 to 47 and that definitely encourages me. I was diagnosed on Dec 23 with 78 or 9.3%. I wish you well and thank you for your detailed input.

 

[finsit]

This is by far the best collection of most of the CGM studies done to understand normal blood glucose levels in healthy population. This combines most of the recent research papers, so you can spare hours of research. Very informative and well written. Could come as a surprise, shock or disappointment (so was for me) but its the real picture. Because the normal blood sugars keep the complications away, i guess this is the right place to post this article?

https://www.levelshealth.com/blog/what-should-my-glucose-levels-be-ultimate-guide

 

[oldgreymare]

This is by far the best collection of most of the CGM studies done to understand normal blood glucose levels in healthy population. This combines most of the recent research papers, so you can spare hours of research. Very informative and well written. Could come as a surprise, shock or disappointment (so was for me) but its the real picture. Because the normal blood sugars keep the complications away, i guess this is the right place to post this article?

https://www.levelshealth.com/blog/what-should-my-glucose-levels-be-ultimate-guide

Thank you for posting this - it is a great summary, but unfortunately doesn't provide much information on the dietary intake in most of these studies (possibly in the underlying papers?). I think most of us would agree that using a CGM to monitor maximum time in range, plus aiming for ideally lower "normal" average BG levels and small standard deviations is gold standard, but in practice this is much easier said than done.

Have done your in depth research as to what to aim for, do you have an agreed strategy with your health team as to how to consistently achieve this?

 

[Mr_Pot]

Here is the table of what are considered normal glucose ranges from the reference in post #28. I have converted the units.

In summary, based on ADA criteria, the IDF guidelines, a person’s glucose values are “normal” if they have fasting glucose <5.6 mmol/L and a post-meal glucose level <7.8 mmol/L. Taking into account additional research performed specifically using continuous glucose monitors, we can gain some more clarity on normal trends and can suggest that a nondiabetic, healthy individual can expect:

• Fasting glucose levels between 4.4-4.8 mmol/L
• Glucose levels between 3.9-6.7 mmol/L for approximately 90% of the day (and to rarely ever go above 7.8 mmol/L or below 3.3 mmol/L)
• 24-hour mean glucose levels of around 4.9-5.8 mmol/L
• Mean daytime glucose of 4.6-5.9 mmol/L
• Mean nighttime glucose of 4.5-5.7 mmol/L
• Mean post-meal glucose peaks ranging from 5.5 +/- 0.6 to 7.6 +/- 1.2 mmol/L
• Time to post-meal glucose peak is around 46 minutes – 1 hour

These are not standardized criteria or ranges but can serve as a simple guide for what has been observed as normal in nondiabetic individuals.

 

[finsit]

Thank you for posting this - it is a great summary, but unfortunately doesn't provide much information on the dietary intake in most of these studies (possibly in the underlying papers?). I think most of us would agree that using a CGM to monitor maximum time in range, plus aiming for ideally lower "normal" average BG levels and small standard deviations is gold standard, but in practice this is much easier said than done.

Have done your in depth research as to what to aim for, do you have an agreed strategy with your health team as to how to consistently achieve this?

Hi thanks for your feedback. Well i did read most of those studies and reference to each of em is given within the article so you can find out the food intake, but as far as i remember, these were typical food containing 50 gms of carbs per meal plus protein plus fat etc. For the past three months, my main research was on finding what is the actual normal level for today's person that i could aim for reducing my carbs. Now if you look at the extreme side (Dr. Bernstein and alike), they always compare your normal blood sugar with your hunter-gatherers who were on protein and leafy veggies most of their life with occasional fruits or honey so their sugar levels must be close to 83 mg/dl around the clock and i am sure their BG wont cross even 90 after meals.

With the invent of agriculture and availability of high-carb food on the go, definitely our habits and probably genes have changed as well. Egyptians are very advanced in research on diet and nutrition and during my last visit couple of months back they say that if you are maintaining anywhere between 95-105 (except the 2 hours after food) you should be all right. They also mentioned that your premeal readings should be same 2 hours post-prandial but doesn't matter if its 83 or 97. So if you start food at 97 or 100, if 2 hours post meal you can come down to 100 then you are fine. (all values in mg/dl)

Now several other research studies also suggest increase in neuropathic/CVD complications in non-diabetics as their fasting sugars start increasing above 85 mg/dl. Again per my understanding at 83 you get the least AGEs production and you get all natural chances of any illness. But i also believe that anywhere up to 120 mg/dl should be safe as long as you are physically active and have at least 150 minutes cardio a week. So one things compensates other. Now here is a very interesting reading from very normal population, probably you will find it in one of those study references in the article i posted above, cant remember which one, but just have a look at the pattern. No one came back to their pre-meal readings in 2 hours, probably it took them good 4-5 hours to come back to pre-meal levels. And these were absolutely normal population who had GTT test passed etc. So its a good thing to rest 4-5 hours before the next meal for diabetic and non-diabetic both to keep the insulin-sugar cycle in a balance and give some rest to ever-busy pancreas.

 

[finsit]

Here is the table of what are considered normal glucose ranges from the reference in post #28. I have converted the units.

In summary, based on ADA criteria, the IDF guidelines, a person’s glucose values are “normal” if they have fasting glucose <5.6 mmol/L and a post-meal glucose level <7.8 mmol/L. Taking into account additional research performed specifically using continuous glucose monitors, we can gain some more clarity on normal trends and can suggest that a nondiabetic, healthy individual can expect:

• Fasting glucose levels between 4.4-4.8 mmol/L
• Glucose levels between 3.9-6.7 mmol/L for approximately 90% of the day (and to rarely ever go above 7.8 mmol/L or below 3.3 mmol/L)
• 24-hour mean glucose levels of around 4.9-5.8 mmol/L
• Mean daytime glucose of 4.6-5.9 mmol/L
• Mean nighttime glucose of 4.5-5.7 mmol/L
• Mean post-meal glucose peaks ranging from 5.5 +/- 0.6 to 7.6 +/- 1.2 mmol/L
• Time to post-meal glucose peak is around 46 minutes – 1 hour

These are not standardized criteria or ranges but can serve as a simple guide for what has been observed as normal in nondiabetic individuals.

Thank you for the summary and the difference here is the word normal vs optimal. Normals are different for ADA, Endo Societies or Europeans but optimal are what are mentioned above.

 

[Mr_Pot]

Thank you for the summary and the difference here is the word normal vs optimal. Normals are different for ADA, Endo Societies or Europeans but optimal are what are mentioned above.

I don't know if I am agreeing with you or not, but the table I reproduced is labelled Summary Of Normal Glucose Ranges in the article and is the measured values of non-diabetics.

 

[oldgreymare]

Hi thanks for your feedback. Well i did read most of those studies and reference to each of em is given within the article so you can find out the food intake, but as far as i remember, these were typical food containing 50 gms of carbs per meal plus protein plus fat etc. For the past three months, my main research was on finding what is the actual normal level for today's person that i could aim for reducing my carbs. Now if you look at the extreme side (Dr. Bernstein and alike), they always compare your normal blood sugar with your hunter-gatherers who were on protein and leafy veggies most of their life with occasional fruits or honey so their sugar levels must be close to 83 mg/dl around the clock and i am sure their BG wont cross even 90 after meals.

With the invent of agriculture and availability of high-carb food on the go, definitely our habits and probably genes have changed as well. Egyptians are very advanced in research on diet and nutrition and during my last visit couple of months back they say that if you are maintaining anywhere between 95-105 (except the 2 hours after food) you should be all right. They also mentioned that your premeal readings should be same 2 hours post-prandial but doesn't matter if its 83 or 97. So if you start food at 97 or 100, if 2 hours post meal you can come down to 100 then you are fine. (all values in mg/dl)

Now several other research studies also suggest increase in neuropathic/CVD complications in non-diabetics as their fasting sugars start increasing above 85 mg/dl. Again per my understanding at 83 you get the least AGEs production and you get all natural chances of any illness. But i also believe that anywhere up to 120 mg/dl should be safe as long as you are physically active and have at least 150 minutes cardio a week. So one things compensates other. Now here is a very interesting reading from very normal population, probably you will find it in one of those study references in the article i posted above, cant remember which one, but just have a look at the pattern. No one came back to their pre-meal readings in 2 hours, probably it took them good 4-5 hours to come back to pre-meal levels. And these were absolutely normal population who had GTT test passed etc. So its a good thing to rest 4-5 hours before the next meal for diabetic and non-diabetic both to keep the insulin-sugar cycle in a balance and give some rest to ever-busy pancreas.
View attachment 48190

"For the past three months, my main research was on finding what is the actual normal level for today's person that i could aim for reducing my carbs." What about uncovering what could be optimal dietary approach rather than "normal", given increasing numbers of health experts are deciding that carbohydrate heavy diets although the norm, especial in SWD/SAD countries, are not healthy. I believe the genetic data shows our bodies' biochemistry is still in hunter gatherer mode (protein/fat based with long fasting intervals) - the switch to grain agriculture over the last 10,000 years is evolutionary wise extremely recent. Check out Dr Jason Fung and Benjamin Bikman as well as the excellent authors that you have already listed.

Please take care not to fall into the trap of false precision - most of physiological and clinical research is predicated on either well controlled double blinded trials (unfortunately usually short term, small samples and far from real life application) or very large long term population outcome studies. The error ranges on BG meters, even CGM, can easily be +/- 15%, so a reading of 100mg/dl could in reality be anything from 85-115. Also the risk ranges are population based - there are no hard predictors of how any single individual will tolerate or not elevated BGs.

Having done so much research reading, are you able to obtain to obtain a CGM or a BG meter with lots of strips to start your own N=1 experiment and to discover what triggers your own BG levels and how many carbs, if any, plus extended intervals between meals (no snacks) to keep them within levels you are happy with. Most of us will concur that this is a many year experiment!

 

[NicoleC1971]

What is the most optimal level of a1c to avoid or reduce diabetic complications?

As a newly diagnosed diabetic, the first question comes to the mind how fast I am going to get complications; or, whether keeping my BG in range, can I avoid or delay these complications; or what’s the cut point in terms of a1c or BG levels for a smooth sailing?

Well, I have been going through 10s of research study and papers recently, some as old as 20 years but then I started searching for more recent articles just to make sure I am updated on the information.

I highly recommend three books that if you have in your library, you will not need anything else to understand all the concepts about diet, metabolic disorder and diabetes and how to keep yourself healthy, or manage if you already have the metabolic disorder. These are;

• Diabetic Solution by Dr. Richard K. Bernstein
• Protein Power by Dr. Michael Eades
• The Art and Science of Low Carbohydrate Living by Jeff Volek

Of course, reading all the research papers and diabetic journals will keep you updated and let you understand more the decades of hard-work put in the above three books.

The quick answer to why diabetic complications happen is the oxidative stress and glycation or AGEs (Advanced Glycation End-products). AGEs are happening in the human body consistently whether you are diabetic or non-diabetic, it’s a continuous process and you can not stop it. However, the level of AGEs production in your body depends upon how high and for how long your blood glucose has been high. The higher the BG and the longer they have been in a higher range, the more AGEs will be produced. If your blood sugar is mostly within the normal range 80-85 mg/dl, your AGEs production will be just normal (so basically you will age like Royals). Relationship of AGEs and complication is U-shaped. So below the normal or above the normal range, your AGEs production will be imbalanced. If you have had high BGs, you are producing more AGEs and hence you will have more complications because of glycation (excessive sugar attaching to your protein). Because this glycation mainly happens at the end points of neuron, it always affect eyes, kidneys, arteries, feet etc. It’s not as simple as it looks because there are lot more processes involved when you have more AGEs in the body that change your mitochondria and cell structure which ultimately produces calcification in arteries leading to cardiac abnormalities.

The bottom line is that more the blood sugar and for longer it stays on higher levels, you will have more AGEs and more diabetic complications. AGEs production in diabetic is 60% more than non-diabetic according to the book BloodSugar101 and that makes sense. The less AGEs you produce the better your chances are to avoid diabetic complications and that is a result of near normal sugars around the clock.

This research study from 2012 shows that the chronic complications were least below the a1c of 6%.

View attachment 48164

https://www.researchgate.net/public...nd_chronic_complications_in_diabetes_mellitus

This is another interesting study of a1c correlation with diabetic complications which shows that an a1c value below 6% is the safe value to target for.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114320/

This is perhaps a more interesting study about diabetic retinopathy occurrence at different FPG and A1C levels. Its evident that prevalence of diabetic retinopathy starts when the FPG starts increasing above 5.5 mmol/l level, or when your PPG starts increasing from 9 mmol/l level, or at HBA1C level of 5.5 which seems like a cut point in this study.

Full study is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005450/

View attachment 48165

I could only find the reference to retinopathy complications, but in another study where the researcher correlated neuropathy and CVD as well, the threshold seems to be the same.

My conclusion (and the goals that I would set for myself) after all those months of research is as follows:

1. Try to keep your A1C as close to 5% as possible
2. Try to keep your fasting BG below 5.5 mmol/l
3. Try to keep your post prandial peak below 7 mmol/l

I know it’s a lot to ask and its really hard to maintain above levels particularly if you are not taking insulin for D2, but the least you should be able to do is to keep 80% of your time in range TIR between 70-120 mg/dl.

Its important to mention that AGEs are not only produced by glycation but can also be added to your body through dietary sources through what is called Maillard reaction or dAGE, however most of these dietary AGEs are excreted from the body and daily limit of dietary AGEs recommended per day is 15000 units/day (or kU/gm), which sounds very high but just a 90 gm pan fried beef steak contains over 8500 of these units.

A safe and optimal dAGE intake for the purposes of disease prevention has yet to be established. However, in animal studies, a reduction of dAGE by 50% of usual intake is associated with reduced levels of oxidative stress, less deterioration of insulin sensitivity and kidney function with age, and longer life span.

Reducing dAGE may be especially important for people with diabetes, who generate more endogenous AGEs than those without diabetes and for those with renal disease, who have impaired AGE clearance from the body

Its very interesting and a relatively new concept but if you really need to read more details about it, here is a full guide including which food has how many AGEs and what type of cooking methods increase or decrease these AGEs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564/

I would be very interested to hear more about your personal experiences with your glycaemic control, number of years of diabetes and any complications that developed or reversed.

Kudos for you for doing your research.
I am type 1 and have already dammaged my eyes through erratic bg control yet it is still very hard for me to get my bg optimal on insulin.
Your research so far seems focused on the blood glucose centric way of looking at complications. I'd also recommend you look at the studies showing that treating type 2 s aggressively with drugs and exogenous insulin did not improve the incidence of complications. Jason Fung (Diabetes Code) and Ben Bikman (Why We Get Sick) bot atribute this to hyperinsulinemia/insulin resistance. Both those books are excellent and illustrate the conclusion of many low carbers here that getting insulin low is as important as getting blood sugars low.

 

[finsit]

"For the past three months, my main research was on finding what is the actual normal level for today's person that i could aim for reducing my carbs." What about uncovering what could be optimal dietary approach rather than "normal", given increasing numbers of health experts are deciding that carbohydrate heavy diets although the norm, especial in SWD/SAD countries, are not healthy. I believe the genetic data shows our bodies' biochemistry is still in hunter gatherer mode (protein/fat based with long fasting intervals) - the switch to grain agriculture over the last 10,000 years is evolutionary wise extremely recent. Check out Dr Jason Fung and Benjamin Bikman as well as the excellent authors that you have already listed.

Please take care not to fall into the trap of false precision - most of physiological and clinical research is predicated on either well controlled double blinded trials (unfortunately usually short term, small samples and far from real life application) or very large long term population outcome studies. The error ranges on BG meters, even CGM, can easily be +/- 15%, so a reading of 100mg/dl could in reality be anything from 85-115. Also the risk ranges are population based - there are no hard predictors of how any single individual will tolerate or not elevated BGs.

Having done so much research reading, are you able to obtain to obtain a CGM or a BG meter with lots of strips to start your own N=1 experiment and to discover what triggers your own BG levels and how many carbs, if any, plus extended intervals between meals (no snacks) to keep them within levels you are happy with. Most of us will concur that this is a many year experiment!

I was asked for a repeat blood test in March 2019, which I couldn't due to my travel etc. Then Covid happened. I was now diagnosed on Dec 23rd 2020 with an a1c of 78. Upon asking i found my a1c in March 2019 was 53... That seems like I must be diabetic for few years now. So my experiments are still very limited but i am burning a lot of daily strips to understand my own body, not to forget that along with insulin resistance, i have family history of diabetes as well.

I have not checked my a1c as of yet which is due some time this month. However, i was able to keep my TIR within 90-130 most of the past three months. If what i understand, my a1c should be somewhere close to 40, fingers crossed.

I have been on SR Metformin 500 twice daily to get out of danger zone initially and now i have reduced it to just night time 500. Its been a week now and i have not seen any significant changes in my readings.

Trust me i did a LOT of experiments on myself, but to summarise it, this is what worked for me so far:

• under 30 carbs a day, with least in the breakfast due to high insulin resistance in the morning.
• i was initially consuming above 90 gms of protein / day but i found it kept my BGs stranded for hours. Now i have reduced it to about 60 gms and it worked well for me.
• I eat veggies in all three meals, green/leafy/onions/mushrooms, you name it.
• a recent experiment did help postprandial, which is 30 minutes bike riding (recumbent home-based bicycle) at a medium speed. So i do about 8-9 km in 30 minutes. I do it 30 minutes before my peak and it nicely reduces my BG about 1 mmol/l or about 15-20 mg/dl. One thing i noticed that because of slow acting carbs and protein diet, i peak 3 hours after meals.
• no snacking/grazing between meals and all meals must be 4-5 hours apart
• last meal 3 hours before bed time
• to avoid dawn phenomenon, now i have reduced carbs in the dinner and added some protein - yoghurt works best for me (Fage/Royal) and i am consistently seeing FPGs close to 5 mmol/l
• i use cream for tea/coffee instead of milk. i have started using decaf lately as i found caffeine did some disruption to my patterns.
• I do an evening walk most of the days and some cardio 3-4 times a week.
• no fruits except few berries here and there with yogurt

Basically that's it after so much tweaking and it seems to be working fine so far. Ah, and the most important thing i learnt was the meal portion sizes. Even eating lot of low carb veggies can affect your BG negatively because of incretin affect upon intestine expansion.

Finally a lot of water even if im not thirsty.

A recent experiment i started and it seems to be helping is cinnamon sticks in green/black tea.

Hope this helps.

 

[finsit]

Kudos for you for doing your research.
I am type 1 and have already dammaged my eyes through erratic bg control yet it is still very hard for me to get my bg optimal on insulin.
Your research so far seems focused on the blood glucose centric way of looking at complications. I'd also recommend you look at the studies showing that treating type 2 s aggressively with drugs and exogenous insulin did not improve the incidence of complications. Jason Fung (Diabetes Code) and Ben Bikman (Why We Get Sick) bot atribute this to hyperinsulinemia/insulin resistance. Both those books are excellent and illustrate the conclusion of many low carbers here that getting insulin low is as important as getting blood sugars low.

Excellent point and i totally agree and have done a lot of reading and listening on that. I just didnt want to mix that topic in this one. This was mainly to focus on BGs and complications. I plan to do a detailed post on hyperinsulinemia as the root cause to prevent or cure diabetes. I am of the view that every person should be checked for his/her insulin levels as part of yearly medical exam to stop the process of metabolic disorder. Since i have discovered and learnt all this, i have checked BGs of lot of family/friends and several of them were clearly on their path to metabolic disorder (my estimates from their readings) and was able to convince them on reducing their carbs

 

[ert]

What is the optimal level of a1c (blood glucose) to avoid or reduce diabetic complications?

My conclusion (and the goals that I would set for myself) after all those months of research is as follows:

1. Try to keep your A1C as close to 5% as possible
2. Try to keep your fasting BG below 5.5 mmol/l
3. Try to keep your post prandial peak below 7 mmol/l

I follow Dr Bernstein's Diabetes Solution. My last HbA1c was 5.5% He suggests 5.3% or lower, to avoid complications. I'm working on it.

 

[finsit]

I follow Dr Bernstein's Diabetes Solution. My last HbA1c was 5.5% He suggests 5.3% or lower, to avoid complications. I'm working on it.

That's a good example of T1 achieving optimal goals. Congratulation

 

[Brunneria]

@zamalik

another subject that you may find as useful and interesting as bg levels, is insulin resistance (IR) and its knock on effect, over time.
There are a whole raft of complications that arise from IR, including heart disease and strokes, cholesterol dysregulation and high blood pressure. Classic ‘metabolic syndrome’.
https://www.dietdoctor.com/cardiovascular-disease-missed-elephant-room
Personally, as someone with bg under reasonable control using diet, I have more concerns about IR causing complications than bg causing complications.