• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

A comparison of the guidelines for control; NICE, ADA, etc.

N

NewdestinyX

Well-Known Member
Messages
205
What have you found is the 'guidepost' for your control in terms of numbers and A1c? Is it informed by more by your "quality of life" issues, i.e "I need to eat at least THIS way - so I'll accept 'these numbers'" or does the research showing the levels where diabetic complications can start motivate you more. And which of the guidelines do you personally follow and why have you made that decision.

Since I'm not from the UK (I'm from the US) this question was put to me in another thread:
Cuglia said:
I see you're from the States newdestinyx.......can I ask do you agree with the ADA guidelines and have you seen the NICE (UK) & SIGN (Scotland) guidelines. I wonder how much they all differ, if at all ?
Click to expand...
Great question. I think the ADA sets a pretty wide net in which they're trying to catch some folks who simply won't do 'ANYTHING' about controlling their D. So they set the standards pretty loose. I don't fault them for that - but for me I prefer the IDF's (International Diabetes Foundation) guidelines which are a little tighter than the ADA. I keep my numbers between 5.0mmol and 7.7mmol all day every day. And I want my A1c under 6.0. Those are my goals.

What are others of your goals and your thoughts about my questions above?

Thanks!
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Good question really from Cugila.

Personally i think it's not a good idea to 'set a wide net' to allow people who don't do anything to control their diabetes fit into whats recommended, i think it will hinder those who do not understand that and won't aim for tight control because they already fit into that pretty wide net.

I think it's good to set a good target, obviously a reachable one, but one that if you are in that target then you are in good odds of leading the longest and healthiest life possible.

Setting a target just so people can reach it is no good in my eyes, it's not going to do some people any favours in the long run.

Ideally my goals are to keep between 5-7mmol. I would like my HBA1c to be in the 6's.. preferably the higher end. i hit my targets of 5-7 currently about 60-70% of the time. Sometimes i sit in the high 4's which is okay but i prefer to be at least 5mmol. Sometimes i go up to 7.5 and that's okay too. but my targets set on my glucose meter with my pump is between 5-7 so my pump will calculate insulin doses needed to bring me smack bang in the middle which is obviously 6

My hba1c at the min is 7.2% this is the lowest its ever been, and i know it is lower because i had a fair few few hypos in the beggining of starting my pump. i'm due another over the next week or so. Im hoping it's either the same or slightly lower as my BG's are now more even, hardly swings anymore.

In football, how boring would the game be if the net stretched 20 feet high and as wide as the pitch, everyone would be able to score a goal. Therefore everyone could be a professional footballer. the game would be naff and nobody would watch it anymore and football stadiums would be empty and tickets wouldnt be sold.

the net's in football aren't set to the size of a window either. Because nobody would score, apart from the super super super talented ones. people would give up with football and not want to play anymore.

The net is set at a reasonable size so it takes skill, practice and effort. But most people when they try can score a goal can't they?

thats the way i see it
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Or soccer as you guys over the otherside call it
 
Re: A comparison of the guidelines for control; NICE, ADA, e

And T1's and T2's are likely going to have a couple of different elements affecting their choices. T1's, who must be on constant insulin need to be careful not to get hypos from over use of insulin. So for them to shoot for A1c's in the low 5's could consist of too many hypos - not healthy. If you're on a PUMP a T1 can achieve lower A1c's than those doing MDI (multiple daily injections).

Another question came up in the 'Fasting am number' thread - that more appropriate here. It was about 'my take' on this issue. Which I didn't mention in my first post in too much detail.. But here's my general philosophy:

First of all I believe it's not my place to judge what's best for others. It's not any of our places to do that. And people can use statistics as weapons. And often leave common sense go out the window. My goals modified over time. The ADA guidelines gave me a target for the beginning of my journey. Once I met those guidelines consistently I, a Type A personality, wanted to see if I could do better and what, if any, benefits there were to trying to go lower. I found conflicting information out there in the scientific community about the 'best targets' for 'all diabetics'. I tell newbies to 'give themselves time' to 'discover' their LONG term goals. And in the short term start making SOME/ANY changes in the right direction which includes exercise addition and carb modification in a downward direction. It took a LONG time for them to get a really high A1c -- it is NOT required they have 'normal numbers' immediately. If they DON'T currently have complications at diagnosis - ANY, even the smallest, changes they make will be 'reversing' damage and squelching the advancement of any complications that may be started. Newbies should not be 'feared' into immediate massive changes. That only shipwrecks progress in my experience reading these message boards. Some people CAN make huge changes immediately. More power to 'em. I could NOT and 'feel well' nor 'do well'. I 'moderated' my way to where I am today. And I'm JUST as healthy and complication free now as anyone who took up drastic measures at dx.

Those are my thoughts. The IDF guidelines of fasting under 5.5mmol and two hour number under 7.7 is a great guideline for me. I personally even want to be CLOSER to the fasting level after 2 hours - but am THRILLED when I'm under 6.6. Though my signature says I'm still on 6iu of Lantus a day -- I've recently stopped that too as I'm convinced it's holding back my weight loss program and keeping me on this most recent plateau. Without it -- my am fasting is a little closer to 6.1 than the 5.0 I'd prefer. But I'll live with it to reach my weight loss goals. From my own experimentation I'm convinced it's the overuse of the basal insulin (not the bolus) that's at the heart of most people's issue who say they 'gain weight' on insulin. All the basal swimming in your blood all day long as a T2 just 'sucks the sugar' from your blood onto your belly - unless you exercise after every meal - which just isn't practical.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

I think you missed out this bit of your general philosophy... And while I appreciate a Type 1 on insulin has to be cautious about hypos, this quote was posted on a Type 2 forum... so I read this as suggesting that none of us (Type 1 or 2) need aim for normal BGs for fear of complications... and yet you do???

I notice you started early on insulin yourself and that you have been advising other new folks to ask their Doctors about that same approach. Surely insulin as an early short-term intensive use (as per 2 small Asian studies) is all about establishing rapid BG control as soon after diagnosis as possible? Not the nice slow "moderate" approach you go to great length to layout above. Again I see contradiction between what you say and what you do.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Well, I'm not Superwoman and I'm not on a pump and I have a very erratic lifestyle, so achieving non-diabetic BS would be completely impossible for me. However, I have had diabetes for 36 years, I have no complications and yes, I do allow my BS to go a bit higher to deal with the extra activity on busy days.

Also, some types of physical activity go hand in hand with adrenalin. There is no way to predict which ones and no way to know if the BS will go high or come down. If I'm going to do a 25 mile horse ride (fast), my BS often goes up because my horse is a bit scary at the start of a ride, but I can never be sure of that, so I never inject assuming that that will happen. The first time i do I can guarantee that the adrenalin will choose that day to not appear and I will have to deal with hypos while dealing with Fella. So no, whatever the guidelines say, mine are a bit more flexible, and my life has quite enough challenges in it that I really don't need to view my diabetes goals as one of them. I try to keep under 10 between meals if I can but with my level of physical activity, it's not always possible to do that and not end up hypo. My ideal goal is to stay in single figures, and I'm not too worried about trying to achieve a low test before meals because if it's a bit higher than the NICE target, I simply adjust my insulin to deal with whatever the pre-meal level is. It seems to work. But don't all go off and do as I do, because your doctors and DSNs would have a fit.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

The IDF guidelines referred to by Grant are T2 guidelines, they don't seem to have a T1 guideline.
I've just been searching for any other than the NICE guidelines.
So far I've found this one from ISAPD and aimed at children and adolescents but I think its quite relevant to adults with T1 as well since much of the evidence they used was from the DCCT which was a study of adults and adolescents..
First it says quite clearly
.
It then has levels of control from ideal (non diabetic) to high risk (action required)
ideal control ie non diabetic
neither raised nor low blood glucose levels
Fasting or pre prandial 3.6-5.6mmol/l
post prandial 4.5-7mmol,
bedtime 4.0–5.6
nocturnal 3.6–5.6
HBA1c >6.5%
Optimal ie for someone (in the case of this guideline a child or adolescent with diabetes)
no symtoms of raised BG
Few mild and no severe
hypoglycemias
fasting or preprandial 5-8mmol/l
post prandia:l 5–10
Bedtime :6.7–10
nocturnal 4.5–9
Hb A1c <7.5 (in the text it suggests for older adolescents <7%)

The next 2 categories are suboptimal and High risk so for example it is sub optmal to have symptoms of high BG levels ( Polyuria, polydipsia,) suboptimal to have episodes of severe
hypoglycemia (unconscious and/or convulsions) and suboptimal to have an Hba1c 7.5–9.0. It is High risk (just included those that apply to adults, there are others for children) to have symptoms such as Blurred vision, skin or genital infections, and signs of vascular complications. A high risk HbA1c is >9.0

I very much doubt if any type 1s could safely achieve non diabetic control in every aspect because even rapid acting insulin lasts up to 5hrs so a normal post prandial level may well result in a hypo later. Basal insulins are also not flexible enough to cope with large overnight flutuations. No doctor would want someone with T1 diabetes aiming for lower non diabetic fasting/nocturnal levels, we can't switch off the cirulating insulin in the same way as a non diabetic so there has to be a margin for safety.
My HbA1c has been in the 5s for a number of years but I certainly have occasional post prandials of above 10mmol and relatively frequent mild hypos.
 
Re: A comparison of the guidelines for control; NICE, ADA, e


Erm, no it wasn't, it was posted in the Diabetes Discussion forum, in the What was your fasting blood glucose number this am?? thread

viewtopic.php?f=1&t=22272&start=165

BTW, well done for starting a new thread on this Newdestiny, rather than allowing the other thread to become clogged by arguement. It would be a shame to see the original thread degenerate into the same old tit for tat and risk being locked.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

frenchkittie said:
Erm, no it wasn't, it was posted in the Diabetes Discussion forum, in the What was your fasting blood glucose number this am?? thread
Click to expand...
You are right of course... it was posted in a thread for both Type 1 and Type 2.

If NewdestinyX wants to keep his threads on topic then I'd suggest he refrain from adding controversial or inflammatory remarks in the middle of them -- no matter how he may try to sneak it in with a smaller font. So long as he does add such editorial I think it is only right and proper to question them... if for no other reason than to allow him an opportunity to elaborate and defend his position. That way we can all have an open and honest discussion.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Well, I am T1, and I can cope with failure, so, I constantly strive to reach non diabetic levels. I have never achieved it, but I am getting closer. It doesn't bother me that I miss my target, as long as I am getting as close as I can. To me a target is somethingto aim at, that is achievable, although it may be very difficult. I guess I have the metality that can cope with not hitting teh target, I know that some need to set achievable targets.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

That sounds exactly like my approach sugar2... normal BGS are what I "aim" for -- even If I don't always achieve them -- so long as it is safe and reasonable to do so.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

:lol: :lol: :lol: :lol: :lol: You are a wise man Bowell.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Bob, I couldn't see your picture although I saw others did. I just got a little tab at the top giving me the option to block as you get on adverts. My adblocker is disabled. Have you got any ideas why I can't see it? I'm sure I'm missing something good. Usually I can see your pictures (and thoroughly enjoy them) but there have been a couple I haven't been able to see. It's not a Mozilla Firefox thing is it? (says she in her usual complete ignorance...)
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Thanks Bob - I've just started watching it on another tab - it's working. I can normally get u-tube videos and can't understand why this one didn't work for me. Will watch the rest now.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

A guideline is what it says it is, a guide a set of figures that suggest minimum stardards of achievement, it provides a target range which prevents complications, but don't forget a hypos, hypo unawareness is also a complication and can not only impact on your quaility of life daily and long term, can cause a swifter death than complications of high blood glucose! so this side of the marker needs the same serious consideration as the high's...

There are other factors that at an individual level you have to pitch into control more so for insulin users and those taking oral drugs that increase insulin production, such as when it comes to retaining your driving licence other activities where having a hypo increases phsyical danger to yourself or others...

But what often seems to be forgotten is that doesn't really matter what the guidelines does or doesn't say it's all about individual choices... which as far as I can see having a choice about what managment Strategy one wants to take seems to have gone out the window!
 
Re: A comparison of the guidelines for control; NICE, ADA, e

There's only a 'seeming' inconsistency when you trying an contrast things that aren't 'opposites' in any way. My entire journey with D to this point has been EXACTLY what I prescribe to a newbie: moderation and time taking. I heard all the 'drop the numbers to normal immediately' mantra, what I term 'scare tactics' and it all it did was 'scare me'. My numbers didn't come down on ultra lo carb OR Metformin which made me so sick. I was trying to increase exercise but at such a lo carb level I had no energy and felt sick all the time even WELL AFTER the so called 'induction period'. My 'induction flu' never went away. So I said 'STOP'.. There has to be a better way. And there WAS indeed a 'better way' -- for me, that is.

First of all I had arrest any complications that had started by my new lifestyle and asked my doc if insulin would help. He was thrilled. I came off Met and never looked back. Moderated my carbs back to to around 120 for a season and then as I wanted to get off weight plateaus I'd go down to the 50carbs a day thing for about a week and a half and it would drop me the next 6-8 pounds and I kept keeping it off. I was not depriving myself. All the time being okay with the ADA guideline numbers and not worrying.

So I basically have spent the entire two years MODERATING my way down to a 'tighter' regimen of numbers. So what I share with newbies is that YOU TOO can moderate down. AND by looking at the T1's who live long complication free lives with A1c's above 6 I see no cause for giving into fear. To have concluded from my paragraph in the other thread that I think a person should never set tighter guidelines later in their journey from when they started - is simply a 'jump' to conclude such and it is NOT what I was communicating (nor what I wrote) at all. So you're seeing inconsistencies where there aren't any. I'm sorry you misunderstood. I 'very much' want to communicate to a newbie to 'try it like I tried it' and to be wary of the voices that say the ADA guidelines are 'killing people'. That's hyperbole, plain and simple. And I don't think it helps newbies or anybody. If you're still confused and see inconsistencies then we'd have to agree to disagree. My approach has been a simple one - worked for me - and I offer that it can maybe help others too. But a person wanting to use the strict approach of a Dr. Bernstein can also have it work for them. I try to live and let live all the while sharing what's worked for me.
 
Re: A comparison of the guidelines for control; NICE, ADA, e

Much Ado About Nothing then

Or Just Lost in translation :?:

[youtube]-0wQkQDNKlU[/youtube]
 
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…