Ideal blood sugar range to avoid damage

[Acheron05]

Hi all,

I am on 22 units of Lantus once per day and between 3-6 units of Novorapid if I eat carbs with a meal (normally eat low carb because I've found it easier so far and prefer it). I've found I don't need to bolus unless I eat carbs.

I am currently sitting at around 5.4 before meals and try to bolus to stay around a peak of 7.5 or so after eating. I understand for type 1 that under 9 post prandial is considered within a good range.

Is there a practical limit before damage definitely occurs? I get that organs can repair over time, but I guess I'm asking about the real long term best average to stay under rather than guidelines.

Cheers

 

[rom35]

Is there a practical limit before damage definitely occurs? I get that organs can repair over time, but I guess I'm asking about the real long term best average to stay under rather than guidelines.

I think, that the same applies for T1D as for T2D - simulate as near as possible the non-diabetes to prevent any organ damages.
See http://www.phlaunt.com/diabetes/16422495.php for the non-diabetes BG.

My targets are: before each meal: max 5.6; spike after meal max 7.7; two hours after meal again max 5.6
As T2D without medicaments I have no problem with hypo...

 

[Deleted Account]

This website is fantastic.
Not only is there a great group of helpful people on the forum, there is also an amazing library of reference material like this: https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html which may answer your question

 

[mountaintom]

Dare I say this. I suspect that people obsess over this a little too much. I think obsessive behaviour is more of a health problem.
I am not for once saying that good blood glucose control is not important. But I do think that these targets are very strict and the margins very thin - especially for newly diagnosed patients.
How did people live long fulfilling lives with diabetes BEFORE test strips and pens? I’m talking about the people that are still alive today that were using glass syringes in the 60’s 70’s and 80’s. I bet their control was not as good.
And also: “too high sugar levels for long periods of time increases the risk of diabetes complications”. That doesn’t say “if you don’t hit these targets every day you will die”.

 

[LooperCat]

You sound like you’ve got great levels!

I’ve set my range on my Libre scanner to 4-7 - I feel good when I’m there. Above 8 and I start to feel revolting! But it’s much easier for me to do that with the Libre, I can comfortably run around 2mmol lower than I ever could when relying on fingerpricks. @mountaintom is right though, it’s easy to become obsessed. I’m quite prone to being obsessed with things (part of being on the autism spectrum, we do like a “special interest”) and I’ll happy monologue on for hours at anyone about it who’s sat still for long enough So I write a blog instead... Actually, for someone like me, it’s actually beneficial to my mental health to be able to indulge my “special interest” rather than be denied it - but we’re all so different, especially when it comes to brain wiring.

 

[pollensa]

Dare I say this. I suspect that people obsess over this a little too much. I think obsessive behaviour is more of a health problem.
I am not for once saying that good blood glucose control is not important. But I do think that these targets are very strict and the margins very thin - especially for newly diagnosed patients.
How did people live long fulfilling lives with diabetes BEFORE test strips and pens? I’m talking about the people that are still alive today that were using glass syringes in the 60’s 70’s and 80’s. I bet their control was not as good.
And also: “too high sugar levels for long periods of time increases the risk of diabetes complications”. That doesn’t say “if you don’t hit these targets every day you will die”.

Of course you dare say this, lovely to hear for a change some refreshing "dare I say" comments straight talking, as I totally agree with your viewing, majority as it seems reading through the lines are obsessed and/or becoming obsessed regards numbers, aims, and what should be or not be, what is the correct level, so many variations, so many recommendations, this has to stop really, and its up to us who have insulin issues to demand a more transparent, non variation of cut offs that exist worldwide, as it will become more of a health problem, a person with normally good health concern, obsessiveness may have negative effect on health overall. New Zealand for example, cut offs which differ from rest of world on A1C which often receive criticism, for their cut off levels, but as they say, they prefer to take a pragmatic view rather than mis diagnose, or over prescribe, and more so label a person especially if margins one number over under not flexible, can cause a decline in what is normally good health on other areas due to being given a label of Diabetes for example.

We need more of these open comments instead of the sheep following the sheep, being from Australia, where they call a spade a spade, no one gets offended, but it seems in UK, sorry! but it seems when one becomes out of the norm in speaking, its taken the wrong way on many occasions, quite unnecessarily sadly.

The system is all about checking blood glucose control, important as you say, and I totally agree, but where is the reasonable line, for ones overall health generally. Everyones blood sugars rise, whether they are normal, pre or diabetic, thats life, sometimes a worry because one is one or two numbers above the expected aimed number, can cause stress, anxiety, and worry, for this, in my personal opinion the Diabetes world, sorry, many wont want to hear this, but I am the one now saying "Dare I say so" and get smacked on the bottom for doing so? wake up, get your act together as currently the system and threshold levels are totally out of control and not in the best interests of all those thousands motivated, making harsh efforts, compromises aiming for a set number! which is unflexible one point either side. this is the crux of the problem as I see it.

Has one every noticed it says if your over xxxxxx, that leaves doubt, why, you think, ahh, does that mean if I am sitting on the cut off I am still viewed as Pre or because I am sitting on the number or over I become diabetic?? This should not be in place.

Again, New Zealand and other countries clearly take that concern doubt away for example. New Zealand state
A1C below 40mmol/mol 5.8% or EQUAL to regarded as normal. This leave clear understanding to those checking, if they are sitting ON THE CUT OFF 40mmol/mol or under they are normal, and if they are over i.e. sitting on 41mmol/mol or above i.e. 41/49mmol/mol indicates pre diabetes caution range, no medications, lifestyle change for 6 months with a review.

Their system having such clarity, is good medical sense in my opinion.

So perhaps, welcoming to all, why dont take a leaf of this cut off level diagnosing unfortunately.

If not, it leads to one becoming obsess unnecessarily.

so come on Diabetes world...why dont the so called experts and committees who decide and lower ranges of cut offs come to a solution in the best interests of patients, doctors, and all, choose a cut off number for A1C and finger real blood, based on medical and clinical support i.e. not Arbitarary, at whim random chosen, those final chosen cut offs should be strictly followed as the criteria number worldwide. Also, making it clear as to the situation of the cut off i.e. does it mean EQUAL TO, which I am sure would be welcomed by thousands of people who have the doubt question, of what category they fall under.

Recently, I noticed that Diabetes co.uk fasting cut off level figure changed from what it previously showed i.e. 108mg/dl, I noticed it suddenly was showing different lower fasting cut off i.e. 100mg/dl which is what America has. I queried this as felt typographical error? and received confirmation I quote below

Thank you for your question. The fasting figure is from the following Public health guideline.

https://www.nice.org.uk/guidance/ph38

Although grateful for time taken to reply to my concern query as to sudden lowering of cut off fasting, as those aiming for 108mg/dl and happy with results, including myself, as I base my aims on this, if ones results now for example are 101, up to 107mg/dl for example, they become under pre diabetic not normal?

As I have always understood the Nice org.uk always had different cut offs to what was shown on diabetes co.UK? although i was guided to view the contents of information, unfortunately, I still did not get an answer as to why the figure lessened from 108mg/dl to 100mg/dl at the end of the day, on Diabetes co.uk website i.e. why did the 108mg/dl not always show 100mg/dl as Nice have shown in their guidelines fasting figure public health guideline, is it to be viewed the 108mg/dl was not the correct level, and now decided to follow the nice guideline and have changed that to 100mg/dl to be the same? I presume so, So I am still a little confused, although respectful and pleased Diabetes Co.Uk professionally, took the time to acknowledge my enquiry and reply.

To stay any obsession regards cut offs and how many times to check overall, I truly feel, we are in the hands of the Diabetes Industry to take responsibility to change this variation and clear doubt areas of numbers for checking and aiming for, with more transparency and clarification and especially some flexi if one is either side of a cut off.

Exactly right another well raised area, re test strips and pens, how did people do without these, then there is the question surrunding this, if I dare say again, Big Business exists, numbers of cut offs lower, one becomes suddenly in a different category, where one did not perhaps have to use or test at all or so frequently, to suddenly due to change of cut off aims, may may not find themselves, having to test more frequently, thus resulting in more expense and anxiety and obsessiveness is the continued question yes or no?

One number although it does not fit all everyones individual circumstances are different, ages, motivation, lifestyle, should be taken into consideration, but at least have one strict criteria cut off world follows with advices, cut off "or equal to". How wonderful that will be, will that happen, I doubt it, but we can live in hope

 

[KK123]

I know it's different for everyone no matter what type you have. I do, however find it very hard to maintain a (non diabetic) 'normal' level. I just can't do it, I eat low carb and that gets me on average around the 5.5 to 6.5 mark which appears to be what my body defaults to no matter what. To get it below that I would have to take at least 1 unit more of insulin but this drops me by around 1mml taking me to 4.5. Now that might be considered ideal but when you factor in the other things that can impact on glucose levels, ie exercise, mood, work, and even what insulin I might still be producing, there is a big risk of it dropping to well below 4.5. I think that is the main difference between type 2 (generally no hypo's) and type 1 (a big risk of hypo's if you are striving to hover in the so called normal 4's).

 

[Wurst]

I try to avoid all spikes and remain < 5.5 and > 4.5 mmol at all times. Attaintable with low carb , high exercise level and a libre. I've read all sorts of reporjts/books where values for when complications can occur differ, so the safest way is to remain in the non-diabetic range.

 

[Mr_Pot]

Of course you dare say this, lovely to hear for a change some refreshing "dare I say" comments straight talking, as I totally agree with your viewing, majority as it seems reading through the lines are obsessed and/or becoming obsessed regards numbers, aims, and what should be or not be, what is the correct level, so many variations, so many recommendations, this has to stop really, and its up to us who have insulin issues to demand a more transparent, non variation of cut offs that exist worldwide, as it will become more of a health problem, a person with normally good health concern, obsessiveness may have negative effect on health overall. New Zealand for example, cut offs which differ from rest of world on A1C which often receive criticism, for their cut off levels, but as they say, they prefer to take a pragmatic view rather than mis diagnose, or over prescribe, and more so label a person especially if margins one number over under not flexible, can cause a decline in what is normally good health on other areas due to being given a label of Diabetes for example.

We need more of these open comments instead of the sheep following the sheep, being from Australia, where they call a spade a spade, no one gets offended, but it seems in UK, sorry! but it seems when one becomes out of the norm in speaking, its taken the wrong way on many occasions, quite unnecessarily sadly.

The system is all about checking blood glucose control, important as you say, and I totally agree, but where is the reasonable line, for ones overall health generally. Everyones blood sugars rise, whether they are normal, pre or diabetic, thats life, sometimes a worry because one is one or two numbers above the expected aimed number, can cause stress, anxiety, and worry, for this, in my personal opinion the Diabetes world, sorry, many wont want to hear this, but I am the one now saying "Dare I say so" and get smacked on the bottom for doing so? wake up, get your act together as currently the system and threshold levels are totally out of control and not in the best interests of all those thousands motivated, making harsh efforts, compromises aiming for a set number! which is unflexible one point either side. this is the crux of the problem as I see it.

Has one every noticed it says if your over xxxxxx, that leaves doubt, why, you think, ahh, does that mean if I am sitting on the cut off I am still viewed as Pre or because I am sitting on the number or over I become diabetic?? This should not be in place.

Again, New Zealand and other countries clearly take that concern doubt away for example. New Zealand state
A1C below 40mmol/mol 5.8% or EQUAL to regarded as normal. This leave clear understanding to those checking, if they are sitting ON THE CUT OFF 40mmol/mol or under they are normal, and if they are over i.e. sitting on 41mmol/mol or above i.e. 41/49mmol/mol indicates pre diabetes caution range, no medications, lifestyle change for 6 months with a review.

Their system having such clarity, is good medical sense in my opinion.

So perhaps, welcoming to all, why dont take a leaf of this cut off level diagnosing unfortunately.

If not, it leads to one becoming obsess unnecessarily.

so come on Diabetes world...why dont the so called experts and committees who decide and lower ranges of cut offs come to a solution in the best interests of patients, doctors, and all, choose a cut off number for A1C and finger real blood, based on medical and clinical support i.e. not Arbitarary, at whim random chosen, those final chosen cut offs should be strictly followed as the criteria number worldwide. Also, making it clear as to the situation of the cut off i.e. does it mean EQUAL TO, which I am sure would be welcomed by thousands of people who have the doubt question, of what category they fall under.

Recently, I noticed that Diabetes co.uk fasting cut off level figure changed from what it previously showed i.e. 108mg/dl, I noticed it suddenly was showing different lower fasting cut off i.e. 100mg/dl which is what America has. I queried this as felt typographical error? and received confirmation I quote below

Thank you for your question. The fasting figure is from the following Public health guideline.

https://www.nice.org.uk/guidance/ph38

Although grateful for time taken to reply to my concern query as to sudden lowering of cut off fasting, as those aiming for 108mg/dl and happy with results, including myself, as I base my aims on this, if ones results now for example are 101, up to 107mg/dl for example, they become under pre diabetic not normal?

As I have always understood the Nice org.uk always had different cut offs to what was shown on diabetes co.UK? although i was guided to view the contents of information, unfortunately, I still did not get an answer as to why the figure lessened from 108mg/dl to 100mg/dl at the end of the day, on Diabetes co.uk website i.e. why did the 108mg/dl not always show 100mg/dl as Nice have shown in their guidelines fasting figure public health guideline, is it to be viewed the 108mg/dl was not the correct level, and now decided to follow the nice guideline and have changed that to 100mg/dl to be the same? I presume so, So I am still a little confused, although respectful and pleased Diabetes Co.Uk professionally, took the time to acknowledge my enquiry and reply.

To stay any obsession regards cut offs and how many times to check overall, I truly feel, we are in the hands of the Diabetes Industry to take responsibility to change this variation and clear doubt areas of numbers for checking and aiming for, with more transparency and clarification and especially some flexi if one is either side of a cut off.

Exactly right another well raised area, re test strips and pens, how did people do without these, then there is the question surrunding this, if I dare say again, Big Business exists, numbers of cut offs lower, one becomes suddenly in a different category, where one did not perhaps have to use or test at all or so frequently, to suddenly due to change of cut off aims, may may not find themselves, having to test more frequently, thus resulting in more expense and anxiety and obsessiveness is the continued question yes or no?

One number although it does not fit all everyones individual circumstances are different, ages, motivation, lifestyle, should be taken into consideration, but at least have one strict criteria cut off world follows with advices, cut off "or equal to". How wonderful that will be, will that happen, I doubt it, but we can live in hope

HbA1c is only a guide to your average BG level. It varies according to how long your red blood cells take to renew and probably other factors and then there is a margin of error in the measurement method. So it is not surprising that different organisations set the cut off points at slightly different figures and vary them when they are reviewed. If the point at which diabetes is diagnosed was raised from 48 to 50 it does not mean that those with an HbA1c of 49 are suddenly cured. Whether you are called nearly pre-diabetic, pre-diabetic or only just diabetic is not really important, you still need to do something to stop it getting worse.

 

[pollensa]

HbA1c is only a guide to your average BG level. It varies according to how long your red blood cells take to renew and probably other factors and then there is a margin of error in the measurement method. So it is not surprising that different organisations set the cut off points at slightly different figures and vary them when they are reviewed. If the point at which diabetes is diagnosed was raised from 48 to 50 it does not mean that those with an HbA1c of 49 are suddenly cured. Whether you are called nearly pre-diabetic, pre-diabetic or only just diabetic is not really important, you still need to do something to stop it getting worse.

Yes, actually this is part correct as you state, if I may, in avoidance of misunderstanding, as I am in spain, when I chat or comment, I refer to the Spanish levels and New Zealand system here in Spain, not referring to any British system formats diagnosing, just speaking generally of my own experience, under Spanish system, I am not saying spain is correct and or England or another country, just commenting on variations. For example, here in Spain, if ones fasting, random and 2hr after eat real blood finger tests albeit based on Arbitrary set cut offs, are all normal levels consistently are not discordant with a normal level A1C, the latter as you say has marginal errors same in spain, then in Spain, a doctor basing on this, especially if patient has no symptoms, has jurisdiction to change medical records from Pre diabetic, my case, to non diabetic range, accordingly if he wishes. As I note, and gained knowledge today, UK has two codes systems diabetes re doctors changing notes or records i.e. remission etc., one caused by medications and another, here in spain we don't have this system, so I guess, I did not know this so you learn something everyday. Interestingly, A1C test life of red blood cells, this is an area I am always bewildered about, as to my knowledge, a diabetic red blood cells may last only 81 days and a non diabetic person up to 146 days? as it seems A1C test is based over period 3 months, even though guideline, to see how much candy has stuck to the red blood cells during this time, as you rightly say its only GUIDE TO AVERAGE INDICATION, however my wonderment creeps in here, the person non diabetic as I see it , will show more candy on the red cells? but that does not mean they have MORE sugar/candy, simply the sugar has been there longer time, and often, this may/may not result in surprise raised higher result? as the A1C system seems to view everyones life span of red cells the same, which may not be the case, is what I find bewildering, nothing is easy, and very complex at the end of the day isn't it.

 

[Bluetit1802]

Interestingly, A1C test life of red blood cells, this is an area I am always bewildered about, as to my knowledge, a diabetic red blood cells may last only 81 days and a non diabetic person up to 146 days? as it seems A1C test is based over period 3 months, even though guideline, to see how much candy has stuck to the red blood cells during this time, as you rightly say its only GUIDE TO AVERAGE INDICATION, however my wonderment creeps in here, the person non diabetic as I see it , will show more candy on the red cells? but that does not mean they have MORE sugar/candy, simply the sugar has been there longer time, and often, this may/may not result in surprise raised higher result? as the A1C system seems to view everyones life span of red cells the same, which may not be the case, is what I find bewildering, nothing is easy, and very complex at the end of the day isn't it.

Very bewildering indeed. I have read that piece of research that says non-diabetic red blood cells live longer but I don't necessarily believe it. Anyone can have long living RBC, and anyone can have short lived ones. The standard 120 days is just some sort of average. The problem is, to have the test to see how long our RBC live can only be done in research conditions because it involves a lot of blood drawing and tests over a period of time. It is never likely to be done routinely, unless new research finds an easier way. It is also possible for anyone to have changes to the lives of their RBC due to various factors, so one HbA1c test we may have long lived ones and the next test just the opposite. There are dozens and dozens of papers on the subject.

 

[Circuspony]

@Acheron05 I saw a consultant yesterday and asked that question. My hba1c is great but within a day I can fluctuate between 3.5 to 14. Apparently most of the research has been done based on hba1c levels and until CGMs were more widely in use no one really understood quite how much of a post eating spike diabetics had.

He said there is no easy answer. A flatter profile is obviously a good thing, but some diabetics are most susceptible to problems no matter how hard they try. Others can go for decades and never have an associated health problem.

So I don't obsess too much. I try to stay between 4-8, but if it hits a higher figure then I just take a unit of insulin and move on.

 

[ringi]

High blood inslin levels also do both short term and long term damaged. So it is not just BG levels, but how much inslin is required to maintain these levels.

 

[pollensa]

Very bewildering indeed. I have read that piece of research that says non-diabetic red blood cells live longer but I don't necessarily believe it. Anyone can have long living RBC, and anyone can have short lived ones. The standard 120 days is just some sort of average. The problem is, to have the test to see how long our RBC live can only be done in research conditions because it involves a lot of blood drawing and tests over a period of time. It is never likely to be done routinely, unless new research finds an easier way. It is also possible for anyone to have changes to the lives of their RBC due to various factors, so one HbA1c test we may have long lived ones and the next test just the opposite. There are dozens and dozens of papers on the subject.

Yes, I too, like yourself, was rather skeptical regards the research article, and seek researches todate 300 pages in all,from reputable sources normally Mayo clinic, diabetes associations NZ Australia, and even WHO World Health in Geneva for facts regards unsureties and questions, being a retired lawyer,always aware importance of 100% true and correct facts to save doubt, I raised the question/ situation to my spanish Doctor, who confirmed this was the case as article stated, more or less, with added confirmation, although lifespan red cells differ in such degree, it must not be forgotten that A1C is not to be viewed superior to real blood finger testing regards diagnosing purposes its simply a general guide over a three month period and its the two together Real Blood finger testing and A1C results here in spain that allow a diagnosis accordingly. As said, its all rather complex and simply put feel it would be wonderful if there was more transparency and in depth information available to all with insulin issues overall would I am sure prove beneficial and welcoming to thousands out there.

 

[annliggins]

I live a healthy, happy life between 5 -10 its good for me i feel normal i watch the carb / insulin stuff but hell we are all going to die of something ... even the healthiest of people so no point in being miserable . Happy medium i say .. figures can spoil it if youre anal ... just my op

 

[Acheron05]

Thanks for all the comments guys. I'm glad that I appear to be on track and that I can relax a bit about my levels. I feel keeping the discipline up is a good thing overall, but I totally get the point about not becoming obsessed about it too. During the two years before my correct diagnosis of type 1, I sustained some damage with my levels reaching 33 mmol/l at times (I had to beg for a meter) and GP reported my kidneys were "leaking" right before proper diagnosis, which sounded pretty scary!

I was pretty miffed for a while that I had to do my own research in order to request a GAD test, but whatever... That is why I am cautious about advice provided by the "authorities" and have found this forum and website to be the best place.

Needless to say, I've found control is far easier with insulin and a correct diagnosis!