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A1C cut-point to avoid diabetic complications

Brunneria said:
@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.
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Thanks B. I understand you can not manage your BG levels with diet alone unless you manage your IR first or there is something that i am not quite getting here? hyperinsulinemia and IR over time is the reason you get the full blow D2 anyway. Most attribute it to your visceral fats and keeping your waistline under 70-80 cm (30 inch) often helps. I would agree that treating blood sugar should not be the main goal, rather treating IR and hyperinsulinemia should be. I would think that keeping your BGs in normal range with the use of insulin or ISAs etc would be dangerous because then you may be leaving IR uncontrolled. What's your point exactly?
 
zamalik said:
Thanks B. I understand you can not manage your BG levels with diet alone unless you manage your IR first or there is something that i am not quite getting here? hyperinsulinemia and IR over time is the reason you get the full blow D2 anyway. Most attribute it to your visceral fats and keeping your waistline under 70-80 cm (30 inch) often helps. I would agree that treating blood sugar should not be the main goal, rather treating IR and hyperinsulinemia should be. I would think that keeping your BGs in normal range with the use of insulin or ISAs etc would be dangerous because then you may be leaving IR uncontrolled. What's your point exactly?
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Not sure the waistline thing is accurate, for one thing 30" waist for a taller man is quite possibly too thin. Some reports dependent on your sex, Below 37" for men and 31.5" for women:
https://www.nhs.uk/common-health-questions/lifestyle/why-is-my-waist-size-important/

Other ways to try and calculate without expensive scanning machines:
https://www.bhf.org.uk/informations...nutrition/weight/best-way-to-measure-body-fat
 
zamalik said:
Thanks B. I understand you can not manage your BG levels with diet alone unless you manage your IR first or there is something that i am not quite getting here? hyperinsulinemia and IR over time is the reason you get the full blow D2 anyway. Most attribute it to your visceral fats and keeping your waistline under 70-80 cm (30 inch) often helps. I would agree that treating blood sugar should not be the main goal, rather treating IR and hyperinsulinemia should be. I would think that keeping your BGs in normal range with the use of insulin or ISAs etc would be dangerous because then you may be leaving IR uncontrolled. What's your point exactly?
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My point is that for T2s, the risks arising from IR are greater than the risks from raised blood glucose, and should be considered a higher priority.

With the additional benefit that reducing IR will have a knock on effect to reduce bgs and deal with that problem too. So go for the root cause, not the symptom.
 
Andydragon said:
Not sure the waistline thing is accurate, for one thing 30" waist for a taller man is quite possibly too thin. Some reports dependent on your sex, Below 37" for men and 31.5" for women:
https://www.nhs.uk/common-health-questions/lifestyle/why-is-my-waist-size-important/

Other ways to try and calculate without expensive scanning machines:
https://www.bhf.org.uk/informations...nutrition/weight/best-way-to-measure-body-fat
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I seem to remember that the waistline measurement thing varies with ethnicity.
 
Mr_Pot said:
I seem to remember that the waistline measurement thing varies with ethnicity.
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I didn't spend a huge amount of time looking into it to be fair bit believe that's true. I know BMI is a bit of a blunt tool but it does take ethnicity into account and gives lower thresholds
 
Mr_Pot said:
I seem to remember that the waistline measurement thing varies with ethnicity.
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If you look at Protein Power book by Dr. Michael, he has given a good formula to calculate your lean body mass, BMI and protein requirements based on your wrist to height measurement (for men) and hip to waist measurement in women, which makes perfect sense.
 
I always thought that the waist size measurement was simply half height? So a 6ft man needs a waist size of 36" or less, while a 5 ft "6 woman needs to be under 33"....
 
zamalik said:
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 :)
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You've doubtless heard the statistic that only 15% of the US adult population DOESN'T have hypertension, abdominal obesity, low hdl/high trig ratio, high blood glucose levels i.e. metabolic disease. Depending on whichever way you look at it this is a health time bomb or an ongoing sales opportunity for the medical/pharma comlex.
 
Brunneria said:
My point is that for T2s, the risks arising from IR are greater than the risks from raised blood glucose, and should be considered a higher priority.

With the additional benefit that reducing IR will have a knock on effect to reduce bgs and deal with that problem too. So go for the root cause, not the symptom.
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I believe that preventing/reducing insulin resistance is massively important for everyone's health as it seems very implicated in inflammatory responses - not just triggering/worsening diabetes, but CVD, Alzheimer's, possibly cancers.
https://www.amazon.co.uk/Why-We-Get...d=1&keywords=ben+bikman&qid=1616148914&sr=8-1

Even though I'm a T1 I do notice that raised BGs for more than a couple hours (whether from food, hard exercise, illness) always correlates to a need to increase my I:C ratios and correction doses. So relationship feels rather chicken and egg.
 
I cam across this interesting study on a healthy Chinese population with BMI of 22 and different age-sets both men/women. I mean i am really happy to take the mean BG levels (both day and night and 24 hr) for a perfectly normal population to further correlate with the normal A1C cut point. From this study, the mean a1c that i calculated seems like 5.2%.

So the conclusion of the study was that they recommend a healthy BG range to be between 70-119 mg/dl > 90% of the time.

https://care.diabetesjournals.org/content/32/7/1188

Any thoughts from your personal experiences?

PS: China is #1 country for diabetic population (probably because of their high population) of over 116 millions as opposed to USA of 31 millions from a recent 2019 data from International Diabetes Fed.
 
Mr_Pot said:
Any clue to what it means?
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Ok my statistics is rusty and never that good, so can't give an informed opinion on the validity of this paper. But it is based on a large population study of adult Danes (all white Caucasians). The authors are suggesting that increased risk of cardiovascular disease, stroke, peripheral arterial disease, peripheral neuropathy and particularly retinopathy, all occur as blood glucose levels increase above low normal levels ( > 4.0 mmol, 72 mg) , so such increased risk is present even at so-called normal and pre-diabetic BG levels. They attempt to show that this risk is incrementally CAUSED by higher BG levels, not just coincidental to these BG levels.

Therefore they are suggesting that it makes sense to do intensive risk screening for retinopathy, CVD, MI, stroke, neuropathy, etc even in so -called pre-diabetic patients. My takeaway is that keeping BGs and HBAC1s as low as possible is critical for susceptibility to these serious health conditions - the various health care boundaries are just"arbitrary" guidelines. But very hard to do in practice in the context of most Western & Asian carb intensive diets.

Big limitation of this study is that it only considers white North Europeans - relevance for other ethnic groups is completely unknown. Still some food for thought?
 
oldgreymare said:
Ok my statistics is rusty and never that good, so can't give an informed opinion on the validity of this paper. But it is based on a large population study of adult Danes (all white Caucasians). The authors are suggesting that increased risk of cardiovascular disease, stroke, peripheral arterial disease, peripheral neuropathy and particularly retinopathy, all occur as blood glucose levels increase above low normal levels ( > 4.0 mmol, 72 mg) , so such increased risk is present even at so-called normal and pre-diabetic BG levels. They attempt to show that this risk is incrementally CAUSED by higher BG levels, not just coincidental to these BG levels.

Therefore they are suggesting that it makes sense to do intensive risk screening for retinopathy, CVD, MI, stroke, neuropathy, etc even in so -called pre-diabetic patients. My takeaway is that keeping BGs and HBAC1s as low as possible is critical for susceptibility to these serious health conditions - the various health care boundaries are just"arbitrary" guidelines. But very hard to do in practice in the context of most Western & Asian carb intensive diets.

Big limitation of this study is that it only considers white North Europeans - relevance for other ethnic groups is completely unknown. Still some food for thought?
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Thanks for you input. Yes i read a couple of studies where they say the risk of cardiovascular diseases increase as you start going above 83 mg/dl and there were other potential risks below that number to, like a U-shaped relationship. And yes these are all guidelines, so best is to keep your insulin as low as possible with BGs under control as well.

Just found this study which probably answers your questions as its on different ethnicities and deals with pre-diabetic ranges and study lengths are several years.

https://www.bmj.com/content/370/bmj.m2297
 
zamalik said:
Thanks for you input. Yes i read a couple of studies where they say the risk of cardiovascular diseases increase as you start going above 83 mg/dl and there were other potential risks below that number to, like a U-shaped relationship. And yes these are all guidelines, so best is to keep your insulin as low as possible with BGs under control as well.

Just found this study which probably answers your questions as its on different ethnicities and deals with pre-diabetic ranges and study lengths are several years.

https://www.bmj.com/content/370/bmj.m2297
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Thanks for sharing. Interesting and easier to interpret than the Danish study I quoted above.
 
Hi all, this study is actually very very interesting showing BG ratio to risk of stroke for both diabetic and non-diabetic population. The results were drawn over a period of 5 years, which is not that long but still can give a good idea of what to target for us diabetics. Also, its very recent study. I am sure you can draw a lot of conclusions seeing the results, but nevertheless its interesting. Look forward to receive your personal feedback on it.

https://www.hindawi.com/journals/ijhy/2020/8953058/
 
Ronancastled said:
You do find some good studies, always a good read
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Thank you and i am happy it was useful. TBH, i was not even aware of insulin 3 months back and now i can give a full hour lecture on insulin resistance and diabetes. When you get it, it changes everything! There is so much in dark regarding complications that anything i think is useful i try to share.
 
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