BG levels

[Dawnes]

Hi I am new to this forum and live in Australia. I have had Diabetes 2 for about 10 years and on meds for 7 years. Recently we have been given new BG levels here. Fasting 6 to
8 non fasting 6 to 10. Previously 4 to 6 and 6 to 8. Has it also changed in the UK? I have found reading the forum to be great and thanks to all those who contribute.

 

[Nyxks]

No idea if anything has changed in the UK, but I know here in Canada is still 4 to 6 before meals and 5 to 10 after meals is the normal range of things … my endro personally wont's me to be around 5 or 7 post meal and 4 to 6 pre meal - which I'm able to do here and there but not as much as I'd like, but its better then i was 10 years ago so its still am improvement that he's tightened things up instead of having it as louse as it was (he was following the general guiltiness above till my a1c came into range - then he tightened my goals).

 

[Robbity]

I've only been diabetic - type 2 - a short while, but (what I believe are still) the UK recommended levels are here. Many people on the forum seem to feel that it's best to aim (as far as possible!) for the non-diabetic levels, and I certainly wouldn't want to up my own targets at all. Have they given any reason for the higher figures?

Robbity

 

[Dawnes]

They are saying that it is the new recommendation based on high level of research. Also a new slogan Don't drive if under 5. Not that my levels are ever under 5.
My Endo says that the reason for the change is that they found no difference in affect on people's bodies using the lower levels.
Quite interesting the differences in approach.

 

[Spiker]

There is a similar argument in the UK, or rather similar medical advice, that below a certain point the short term disadvantages of tight control (hypos) start to outweigh the long term benefits. Or more bluntly, if you are dead from the consequences of a severe hypo, who cares if you had reduced complications.

A lot of the argument hinges on whether people's BG is tight and stable, or tight and erratic, and what the likelihood of losing hypo awareness is when you run tight control. There are various views on this.

 

[jack412]

Hi I am new to this forum and live in Australia. I have had Diabetes 2 for about 10 years and on meds for 7 years. Recently we have been given new BG levels here. Fasting 6 to
8 non fasting 6 to 10. Previously 4 to 6 and 6 to 8. Has it also changed in the UK? I have found reading the forum to be great and thanks to all those who contribute.

as spiker suggested, they are for T1..as a T2 and if on non hypo inducing meds, I can get down to 3.5 without any concern and try to keep 2hr after meals under 8, under 7 is better
http://www.phlaunt.com/diabetes/14045524.php

some low carb diet stuff
http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm
http://www.dietdoctor.com/lchf
http://www.myfitnesspal.com/

 

[phoenix]

If you have a look at this document here
http://www.diabetesvic.org.au/living-with-diabetes/balancing-blood-glucose
It says
Target levels 6–8mmol/L fasting and before meals
6–10mmol/L two hours after starting meals
It gives a reference to the guidelines which actually aren't that recent, they were written in 2009. These give all the details/evidence they used to come up with these figures http://diabetesaustralia.com.au/PageFiles/763/Final Blood Glucose Control Guideline August 2009 (2).pdf
(it's a long document but includes all the reasons why the HbA1c level was set at around 7%... some large trials suggested that people with T2 using medication to lower HbA1c nearer to normal levels didn't necessarily achieve better outcomes,particularly for cardiovascular disease and mortality ( tighter control did improve the incidence and progression of micro vascular disease.) Hypoglycemia is also a factor with some medications
They then set the fasting/post prandial targets at levels needed to achieve around 7%

 

[Dawnes]

If you have a look at this document here
http://www.diabetesvic.org.au/living-with-diabetes/balancing-blood-glucose
It says
Target levels 6–8mmol/L fasting and before meals
6–10mmol/L two hours after starting meals
It gives a reference to the guidelines which actually aren't that recent, they were written in 2009. These give all the details/evidence they used to come up with these figures http://diabetesaustralia.com.au/PageFiles/763/Final Blood Glucose Control Guideline August 2009 (2).pdf
(it's a long document but includes all the reasons why the HbA1c level was set at around 7%... some large trials suggested that people with T2 using medication to lower HbA1c nearer to normal levels didn't necessarily achieve better outcomes,particularly for cardiovascular disease and mortality ( tighter control did improve the incidence and progression of micro vascular disease.) Hypoglycemia is also a factor with some medications
They then set the fasting/post prandial targets at levels needed to achieve around 7%

 

[Dawnes]

Thanks Phoenix, thats great info. Actually they have just been introduced as standard practice in Australia on July 1st this year. And there is a real push for people not to drive if their BG is less than 5. I find it interesting that the recommendations are not standard across developed countries.

 

[Daibell]

The UK follows NICE Diabetes Pathway guidelines which unless they have changed say something like 8.5 mmol max two hours after a meal. I agree with other posters who suggest if you have good control and know what you are doing then go for less than 10 mmol as this will be nearer a non-diabetic person's levels

 

[Nyxks]

I don't understand how having tight control would be an issue - my mom has had tight control of her D and at normal numbers now because of it (she's T2 - at 80 y/o n is 100% diet controlled), i'm striving for better control, tight not so much I figure if I can get a steady even level that is in good range (between 4 and 6 then I'm good).

 

[jack412]

I don't understand how having tight control would be an issue - my mom has had tight control of her D and at normal numbers now because of it (she's T2 - at 80 y/o n is 100% diet controlled), i'm striving for better control, tight not so much I figure if I can get a steady even level that is in good range (between 4 and 6 then I'm good).

we get use to having/reading high numbers that we forget normal starts at 3.5 and goes to 5.5 fasting
https://www.google.com.au/webhp?sou...ormal blood glucose fasting levels 3.5 to 5.5

if you take hypo inducing drugs, you need to run a higher normal, say 6, so that when you hypo, it stays above 3 to 3.5
under 3 isn't good for anyone
but over 7.8 causes damage, so 10 isn't the ideal number 2hr after meal
http://www.phlaunt.com/diabetes/14045524.php

 

[Adelle0607]

If you have a look at this document here
http://www.diabetesvic.org.au/living-with-diabetes/balancing-blood-glucose
It says
Target levels 6–8mmol/L fasting and before meals
6–10mmol/L two hours after starting meals
It gives a reference to the guidelines which actually aren't that recent, they were written in 2009. These give all the details/evidence they used to come up with these figures http://diabetesaustralia.com.au/PageFiles/763/Final Blood Glucose Control Guideline August 2009 (2).pdf
(it's a long document but includes all the reasons why the HbA1c level was set at around 7%... some large trials suggested that people with T2 using medication to lower HbA1c nearer to normal levels didn't necessarily achieve better outcomes,particularly for cardiovascular disease and mortality ( tighter control did improve the incidence and progression of micro vascular disease.) Hypoglycemia is also a factor with some medications
They then set the fasting/post prandial targets at levels needed to achieve around 7%

So with this hba1c do we aim for something higher? Or is it just for those t2s who have been lowered by meds? So what hba1c should we target I'm confused now. Thanks!




Uh

 

[Adelle0607]

I think the ones with lower hba1c was associated with the tendency for hypoglycemia may be? For the cardio and mortality risk? Can we highlight the article in detail?

 

[phoenix]

The Australian guidelines were written at a time when there was considerable discussion about the outcomes of trials which aimed to lower glucose levels to 'normal' in the hope of reducing heart disease in people with diabetes. These trials were using medications rather than 'lifesyle'
The Accord trial which was the one that showed poorer outcomes used very agrressive treatments (multiple medications and reduced levels quickly with an aim of getting HbA1c below 6 in a few months) This trial was stopped early because there were more deaths in the intense control arm than the control arm.

Neither of the other trials, which lowered levels more slowly showed any benefit for CVD outcomes (no detrimental effect either). The Advance trial was actually an Australian trial and compared the outcomes of those whose target was below 6.5% with those whose target was 7%.
The other from the US compared a target of less than 6% and 8-9%

Most of the subjects in all three trials were over 60

Here is what seems a straightforward and balanced account written to explain about the three trials and some of the important issues/questions related to them.
The list of caveats they give is important.
http://diatribe.org/issues/10/learning-curve

Since then there has been far more analysis of the data from these trials and the more recent Canadian guidelines have a range of targets with age and other illnesses taken into account. Again though hypoglycaemia is the 'barrier' to lower levels in those who are younger and have no other 'co-morbidities'
Of course as individuals we tend to believe (or want to believe ) that we still have longer life expectancy etc The guidelines tend to take a more pragmatic view but they are looking at PWD as a whole not highly motivated individuals.

(evidence comes first then scroll down for actual guidelines)
http://guidelines.diabetes.ca/Browse/Chapter8
this is the written conclusion

Conclusions
Contrasting results from recent studies should not discourage physicians from controlling blood glucose levels. Intensive glucose control, lowering A1C values to ≤7% in both type 1 and type 2 diabetes, provides strong benefits for microvascular complications and, if achieved early in the disease, might also provide a significant macrovascular benefit, especially as part of a multifactorial treatment approach. More intensive glucose control, A1C ≤6.5%, may be sought in patients with a shorter duration of diabetes, no evidence of significant CVD and longer life expectancy, provided this does not result in a significant increase in hypoglycemia. An A1C target ≤8.5% may be more appropriate in type 1 and type 2 patients with limited life expectancy, higher level of functional dependency, a history of severe hypoglycemia, advanced comorbidities, and a failure to attain established glucose targets despite treatment intensification