How high is high, and how do the risks increase?

[barrym]

Browsing these forums I see folk who keep their levels very low and worry at the slightest rise or spike. Then there are others who have levels in the teens or higher regularly and don't seem too concerned. Who is right? I have thresholds in my mind over which I get concerned, but I don't really have any sound reason for this. No one had ever said to me what constitutes high, or how much the risks go up, or even what the risks are at different levels. What is the risk if you spike for an hour or two at say 15 but then go back below 8? What if you are consistently at 10 or so for a whole day?

Is the increased risk reversible, ie if you were high for a week, then got back in control would the risks diminish again? Should I be talking timescales of days, weeks, months or what?

Am I over simplifying? I've had a working life in IT where most things were quantifiable and predictable, and this damned diabetes just doesn't seem to behave at all, so frustrating

Cheers
Barry

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[ElyDave]

I'm with you there Barry. Just newly diagnosed myself, and from an engineering background where a sound dose of logic and first principles can solve most problems on plant, then along comes this diabetes lark to throw a spanner in the works.

I have been thinking exactly the same recently as I've been trying to keep my levels as steady as possible, within my target range and keep my post meal peak as small as possible. I'm particularly happy when I see a +2 hour reading either slightly less than, or less than 0.5 above the pre-meal, despite the guidance being +2.0. I get pretty annoyed with myself if I see >8.0 to be honest.

Am I trying to get too high a degree of control?

 

[barrym]

I'd love those levels. Those are the sort of numbers I have in mind, but can hardly ever achieve them, and certainly not consistently. My DN says don't worry about +2hr testing, aiming to get these can often give lows by the next meal. She says aim for 5-7 before each meal with any curve in between. I wouldn't mind that either. I'm struggling to get two days the same, but should I be worrying, that's the question.

Barry

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[mo1905]

Good question Barry. I too would love an answer but I don't think there is one. I'd liken it to asking what is the difference in potential harm if I smoke 15 cigs a day to 25 a day ! I know the analogy is different but hopefully you get my point. Every diabetic is different and some will get complications whilst others won't.
I agree it can be extremely frustrating when you see numbers in the double figures when you feel you've done everything right. Trouble is, you can quite easily become obsessed with diet and BG readings. Not sure what the answer is, not even sure there is one. Hope I get corrected ;-)


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[WeeWillie]

Hi Barry,
I'd be very interested to read the definitive answer to to your question, if there is one.

Obviously I don't throw caution to the wind, but due to my eating habits (I've difficulty eating a lot of food stuffs) I just cannot control my levels.
Readings range from (today for instance) 9.5. Then other days it will be up to 20 or slightly over at times.
I do my best to be as sensible as I possibly can regarding food intake, but neither do I dwell on worrying about it.

There has been four non-consecutive occasions over the last few months where my levels have ranged from 5.9 to 9.5. Naturally I was thrilled with those readings. I know the reason, however it wasn't food related.

I've been meaning to send in a post regarding it, so thank you for the reminder.

All the best with your post and as I mentioned, I'll be very interested to read any replies you receive.

Best wishes.

willie.

 

[Embabe25]

I have swinging sugars. I hypo everyday and have highs too but my HbA1C is 7.2. Not great but not too bad. Doc says keep doing what I'm doing.


It's 3.30 in the morning and I'm eating a mars bar in the dark, shaking like a leaf! ***!


Em x

 

[dawnmc]

My nurse also said don't bother with +2 hr testing , which I thought was mad, how else am I going to know what food affects my BS.

 

[sw11bloke]

I too was advised by my DST and Dafne group that as long as your readings are between 5-7 pre meal, then it does not matter how high they spike post meal.
I have also been advised not to test after a meal unless i do feel high 2 hours post meal. My DN is not very keen on correction doses unless I am over 10 and am feeling high.

Question for Embabe?
"It's 3.30 in the morning and I'm eating a mars bar in the dark, shaking like a leaf! ***!"

Do you often have hypos at 3:30am? If so....I think your BI is too high. Also eating a mars bar would play havoc with your readings the next day. Have you ever thought of using 3 glucotabs and a biscuit or 100ml lucozade and a biscuit?
The glucose in the tabs/lucozade works faster and using that dose wont give you a huge spike after the hypo. My dr told me that having a hypo and then the spike is what causes damage and that I should avoid that spike at all cost. Remember that when you hypo, your liver also dumps glucose into your blood so over treating the hypo would give a huge spike. Its those types of spikes which cause damage to the eyes.

 

[barrym]

I agree, lows to cause a rebound effect, in me anyway, which take quite a while to dissipate.

I have just restarted taking Lantus again. Starting with 6 units at tea time, and after a week, I increased to 9. This was too much it would seem, as I awoke with low readings, one just 3.4, and the levels for the rest of the day were up between 10 and 12. I dropped to 6 again last night, had a better reading this morning, and am hoping for a more consistent day.

Fingers crossed.

When you say spikes can damage eyes, I'm sure you are right, but 'how high a spike'?

Barry

 

[sw11bloke]

Hi Barry

My Dr says anything over 11 is not great.
I have also been speaking to a guy who has had type 1 for 32 years and who does not have any complications. He also says 11. If its worked for him for 32 years without a complication, then Id go on that too. Running between 5 and 10 is ideal for a type 1. Even if you do spike to 15 after a meal, its ok as long as you within normal target before your next meal

 

[elaine77]

I've always wondered about this aswell... Whether very rare high reading will cause complications even if ur ok most of the time?

Personally I start to get stressy and angry when I go above 8 mmol post-prandial.. I also get angry about my before breakfast reading always being above 7 mmol but I have also heard that the HCPs say that post prandial doesn't matter aslong as ur before meals is ok? My before meals is always between 4 and 6 which is good but I've also heard that spikes are dangerous which would suggest that post-prandial IS important?

There's just too much conflicting information I'm not convinced even the medical profession know the answers to these questions to be honest....


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 23 currently controlled by only Metformin, 500mg twice a day.

 

[mo1905]

The medical profession seem to focus on the HbA1c reading. Trouble is, if your average is 8 for instance, your team may tell you this is very good. However, this average may well arise from lots of time spent at 4 or 12, both not great. It's very difficult and I still believe there is no magic formula. We just have to keep trying our best and forgive the odd low or high otherwise we just go through life chasing the Holy Grail and desperately unhappy.
Mo


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[sw11bloke]

well said Mo
I agree but I think its v important that every diabetic sets themselves a target that they try not go over. My HB was 12% and during the last 3 months I set myself a target of not allowing myself to go over 11. My HB has now dropped to 8%. For me this is working. Hopefully I will get down to 6/7% by the end of the year.

Planning meals is certainly easier than chasing readings.

 

[justmeint]

My understanding is that with all the glucose spikes and insulin spikes we are actually doing invisible damage to our vascular system... of course they only remain invisible for a few years maybe before something shows, like an ulcer that will not heal or eye issues - bleeding. So with this in mind I changed my entire lifestyle and have gone low carb with adequate protein and lots of healthy fats. I hate to be hungry and with this way of eating I am not..... unless I have eaten something carb heavy..... :thumbdown: that is when the hunger animal in my stomach growls and I know I ate the wrong thing.

I honestly believe you can curtail this beast - quieten it down and make it behave itself by changing your eating habits, which in turn lowers your glucose spikes ---- which in turn lowers you need for insulin and allows some of the hidden damage to repair itself.... :clap:

 

[charon]

Don't think there is an answer.
First we need to look at the question.
Are we just talking about the avoidance of complications or thinking about quality of life or how we feel.
For me I need to be alert as I am studying but also want to avoid complications - apart from that I don't care.
Then we ask what affects these things - is it just bg or could it also be other factors. I suspect it is a combination which is why there will never be a definitive answer.
It could be that low carb diets are good for controlling bg but worse for you in other ways - I think this is what the medical profession is cautious about but won't say so because it means admitting they don't know.
It even seems difficult to find out why high bg is bad - it causes complications but the exact mechanism is difficult to find - was difficult enough to find anything giving a direct link to high bg.

I am a bit surprised with the growth of diabetes that more research isn't being done or published - lets not go into food and drug industry conspiracy theories.


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[charon]

To get back to your question and assuming it is about complications.
I read early on that nerve/circulatory damage is irreversible (don't believe that). Which would mean that if high bg causes this immediately then spikes are bad.
But is an up and down to 15 over an hour worse than going to 10 and recovering over 4 hours?
That brings in the question of low/high gi and eating little and often.

My nurse said I would eventually need insulin and would have complications I have a different one now but I'm going to put these questions to her. Suspect the answer will be not to worry and just keep the HbA1c down.


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[hanadr]

Non diabetics have blood glucose levels that stay close to 5 all the time. If they have a spike, it's short lived. I've allowed lots of non-diabetics to play with glucometers and only ever found 1 who had a level of 8 [after a pasta bake lunch] none of the other group members was above 7. That young doctor was a member of a group at high risk for T2!
It's believed that it is the circulating glucose which damages micro blood vessels and causes "diabetic complications".
For this reason, I try to keep my own bg below 6 and manage it most of the time. I also believe that side effects from medicines can be worse than the original problem, so I'm still using only 2 x 500mg metformin per day [after 10 years!] Although Ihave changed to the SR version, which seems to have calmed my irritable bowel symptoms.
Hana

 

[LittleWolf]

2 of my GPs think spiking to 19 is fine even for a non diabetic...

Personally I think 4-6 pre meal and 6-11 post meal should be good but what do I know lol


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[Embabe25]

I usually do treat with sugary juice. Sugar was 14 before bed. I was using what I found in a drawer as my baby was sleeping beside me and I didn't want to wake her.

Tonight's hypo happened at 2 am. Sugar was 1.6. I did have a snack before bed too.

I have no idea what I'm doing. I take a whack of insulin and hope for the best. At my last app the doc said he was happy with my HbA1c (7.2). Just to keep doing what I was doing! Can't go the dafne course as I have 2 small children and finding someone to look after them that long is impossible!


Em x

 

[Embabe25]

Forgot to say I've not had nights like this since I was pregnant. Over a year ago and I'm defo not pregnant!


Em x