Confusion about bG target levels

[Anonymous]

I have been assuming that the NICE guidelines are as published elsewhere on this site. Specifically, a non-diabetic fasting range is stated as 4.0 to 5.9. However, I have been informed by someone on this site that the NICE non-diabetic fasting range is 3.5 to 5.5.
I start to hypo at around 3.9 and 3.5 sounds low for anyone, so am surprised by these figures. Any ideas/comments?

 

[Anonymous]

I think the clue is in the word guidelines - they're just that. The problem with guidelines is that many people see them as hard and fast rules, when in fact they are nothing of the sort!

It has to be difficult to get a one size fits all as we're all individuals.

I would say go with what works best for you. I aim to be in the 5s most of the time now but, have had the odd mid to high 7. Luckily I haven't had a hypo and as a type 2 I'm at a very low risk of that - unless I go mad on the exercise without eating which is unlikely.

What is your normal Blood Glucose readings for a day? How often have you had a hypo? If only once in a blue moon and you've been able to manage it I would suggest you're in a good place.

I know from experimentation that after a meal my bG drops by about 1.0 every 20 minutes. Last night, I tested myself 1hr 55mins after spag. bol. and I was 6.9. Twenty minutes later (2hrs 15mins) I was 5.9. So, as you say, the 2 hours after is only a rough, but nevertheless useful guide and I use the higher figure. That's why I work on averages over a period rather than specific meals. To be honest, I've tested myself far more in the last couple of weeks than I have in the last 5 months just to have some figures to talk about and my eating habits have been pretty much the same over a long period.

My daily average is currently 5.9 and also per week for the last two weeks (Bank Holiday skewed the readings a bit!). I would estimate that it runs at about 5.6ish over a longer period. Individual evening meals leap around between about 6.0 and 8.0 (the latter is rare), but, as I've said before, my bG drops quite rapidly and I don't believe that individual, temporary spikes contribute to 'persistent high blood glucose' which is what we are all ultimately trying to avoid.

I hypo a couple of afternoons per week during the 4th dog walk (about 3.5 but have been down to 2.9). Of the 250-350g carbs per day they are geared to the evening more than daytime which I think is the problem. I have now started to munch an apple at the start of the walk which seems to be enough to stave off or fix the hypo symptoms.

I know that many people swear by low-carbing but, in my case, if I dropped my carbs to, say, 80g per day, I would be a goner!! I suppose I am low-carbing in the sense that I have reduced portions to the point where my bGs are OK and I am slowly losing weight, so it's different degrees of the same thing. I just started from the top end rather than the bottom end.

 

[hanadr]

No-diabetics have Bgs around 5; MOST of the time.
most non-diabetics will drop to 3.5 when hungry and unless this is caused by medication, it's perfectly normal. If you get hypo symptoms at around 4, you are accustomed to a BG which is probably a tad too high. I run my bg as close to NORMAL as I can and feel absolutely fine at 4 or 3.5. Since I rely mainly on diet [and 2 x 500mg metformin per day] I'm not at any real hypo risk.
Your body adapts to high BG if you let it There is a theory that it's not the actual level you feel, but the drop, so it's possible to have hypo symptoms at quite high bg levels
Hana

 

[Anonymous]

So, as you say, the 2 hours after is only a rough, but nevertheless useful guide and I use the higher figure.

I was referring to the range of Blood Glucose figures that NICE specify rather than the generally accepted timing of when the test is performed. Although, there's probably a personal element involved there too!

just wanted to clarify that.

Ah! OK. I don't know if NICE has guidelines for daily bG. The targets specified by NICE which are replicated on this site, for non-diabetics, are 4.0-5.9 (fasting) and under 7.8 (post-meal, measured two hours after). Taking the two highest that would give a daily average (max) of 6.9 using the NICE targets. That seems to tie in with the 'floor' for persistently high blood glucose of 7.0, which is the level at which the risk of possible complications begins or increases, the emphasis being on 'persistent' or 'chronic'. I can't find a clear definition of 'persistent' in terms of period of time, but I have to admit that I am assume that fluctuations in and out of that zone do not constitute 'persistence'. My risk, I guess.

 

[janeecee]

I'm very confused about the timing of postprandial readings. I'm new to all of this anyway, but I've found that I've been higher at 3 hours postprandial than at 2 hours, and my levels can fall off very slowly some evenings. I don't know whether the 7.8 cut off assumes a higher blood glucose spike at 30-90 minutes, for example, or is it assumed to be the upward limit of a postprandial spike—and if so, wouldn't it be better to test at 1 hour? But then, what if you spike at 3 hours? Very confusing.

 

[Anonymous]

I'm very confused about the timing of postprandial readings. I'm new to all of this anyway, but I've found that I've been higher at 3 hours postprandial than at 2 hours, and my levels can fall off very slowly some evenings. I don't know whether the 7.8 cut off assumes a higher blood glucose spike at 30-90 minutes, for example, or is it assumed to be the upward limit of a postprandial spike—and if so, wouldn't it be better to test at 1 hour? But then, what if you spike at 3 hours? Very confusing.

I know what you mean. I seem to lose about 1.0 every 20 mins after 2 hour test (and probably before). I have also had a few which have gone up after 3 hours... e.g. 8 to 9. Not sure where the extra glucose came from unless my liver was doing something strange... three hours seems a long time for slow-release carbs. Maybe my meter or fingers were contaminated?

 

[janeecee]

I think you're right about lower GI meals, if they contain more fat and protein they seem to take longer to digest. I can't afford to lose too much weight so I can't go too low with the carbs either. I'm trying to work out a way of consuming enough carbs without the spike, but I don't want my levels to be too high for too long, and back to a fairly good bedtime level. As I've added more protein to my diet my levels seem to be higher at bedtime and slightly higher in the mornings—but all this is new to me, I guess there could be other explanations.

 

[mrman]

No-diabetics have Bgs around 5; MOST of the time.
most non-diabetics will drop to 3.5 when hungry and unless this is caused by medication, it's perfectly normal. If you get hypo symptoms at around 4, you are accustomed to a BG which is probably a tad too high. I run my bg as close to NORMAL as I can and feel absolutely fine at 4 or 3.5. Since I rely mainly on diet [and 2 x 500mg metformin per day] I'm not at any real hypo risk.
Your body adapts to high BG if you let it There is a theory that it's not the actual level you feel, but the drop, so it's possible to have hypo symptoms at quite high bg levels


The above may be true for non diabetics and type 2.

A safe range for type 1s is a little higher, as insulin can cause very sudden drops for various reasons so hypo awareness should kick in at around 4 mmol, to give time to either eat or drink a small amount of carbs. having hypo awareness at 4mmol does not mean you are used to high levels but more an indication of very good control. I'm very happy with my current levels, fasting around 5, pre meal 5~7 and post meal 6~8 with only the occasional blip. My last hba1c came in at 6.1 which is excellent for a type 1. I am on a pump though. Keeping in these levels for a period of time helps my body to recognise both 4ish mmol and also if too high. Also the other reason for a type 1 to stay above 4 specially for drivers is you have to be 5mmol before driving and would also advise 5mmol before excercise from walking to running/bathing/being intimate with someone and many other reasons.

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[Anonymous]

No-diabetics have Bgs around 5; MOST of the time.
most non-diabetics will drop to 3.5 when hungry and unless this is caused by medication, it's perfectly normal. If you get hypo symptoms at around 4, you are accustomed to a BG which is probably a tad too high. I run my bg as close to NORMAL as I can and feel absolutely fine at 4 or 3.5. Since I rely mainly on diet [and 2 x 500mg metformin per day] I'm not at any real hypo risk.
Your body adapts to high BG if you let it There is a theory that it's not the actual level you feel, but the drop, so it's possible to have hypo symptoms at quite high bg levels


The above may be true for non diabetics and type 2.

A safe range for type 1s is a little higher, as insulin can cause very sudden drops for various reasons so hypo awareness should kick in at around 4 mmol, to give time to either eat or drink a small amount of carbs. having hypo awareness at 4mmol does not mean you are used to high levels but more an indication of very good control. I'm very happy with my current levels, fasting around 5, pre meal 5~7 and post meal 6~8 with only the occasional blip. My last hba1c came in at 6.1 which is excellent for a type 1. I am on a pump though. Keeping in these levels for a period of time helps my body to recognise both 4ish mmol and also if too high. Also the other reason for a type 1 to stay above 4 specially for drivers is you have to be 5mmol before driving and would also advise 5mmol before excercise from walking to running/bathing/being intimate with someone and many other reasons.

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Interesting points. I have looked upon my hypos (3.9 down) as my body telling me I need energy. I can't quite see how I can 'train' my body to be comfortable with less energy, apart from losing weight perhaps and reducing the 'demand'. I decided to sit quietly doing or eating nothing during a hypo of 3.9 and after about an hour I was up to 4.2 and feeling fine again, which was interesting. Not quite sure what to make of it. Divine intervention by my liver perhaps? :lol: Maybe it's what happens to me during night-time fasting perhaps... a delay between dropping below 4.0 before the saviour steps in?

 

[mrman]

Yep, thats the way I see under 4 as seeing I need energy. Not so much if I sat around lol but if I was just walking the dog with maybe 1 hour of quick acting insulin left I would definitely need some sugar. Less of a problem on pump as I can put a temp basal on 30 mins or so before hand. On mdi I would have regular hypos usually in the high 2s. Since pumping I have virtually no hypos and am always noticing when around 4 as I try to stick to 5. I think if you can manage to stay between 5~8 the majority of time the body recognises when out of these ranges . No science behind it just what I have deduced from my body lol. I appreciate this may not work for all.

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[Anonymous]

Yep, thats the way I see under 4 as seeing I need energy. Not so much if I sat around lol but if I was just walking the dog with maybe 1 hour of quick acting insulin left I would definitely need some sugar. Less of a problem on pump as I can put a temp basal on 30 mins or so before hand. On mdi I would have regular hypos usually in the high 2s. Since pumping I have virtually no hypos and am always noticing when around 4 as I try to stick to 5. I think if you can manage to stay between 5~8 the majority of time the body recognises when out of these ranges . No science behind it just what I have deduced from my body lol. I appreciate this may not work for all.

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Cheers for that. I think we know as much as many scientists do! I would never have thought that I would spend so much time examining my blood glucose behaviour in such detail.

 

[mrman]

Agree gezza, I wouldn't go as far to say we members know more than a specialist but very close to it lol. Spent hours/days/years researching diabetes and liver functions etc as well as other autoimmune conditions so I know the signs and symptoms to look out for. A but pcd at times maybe. Found out diabetes can but Not always results in further autoimmune conditions as or immune system is /has ben under attack already.

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[academicdiabetic]

Hi,

Now, here's an interesting one... I have tried for a while now to find out where the 'accepted' ranges for BG come from... diabetes nurses and consultants have no clue (ask them)... there is very little available research (try Medline..)... the one epidemiological study I have been able to trace (which my consultant lached on to, whether accurately or not, as the one which gives 'definitive' normal BG levels for the UK population at least) gives some interesting figures. For example, a 'normal' resting BG is 14.7 for women over 50... so, why would any of us aim for a resting level of between 3-5 (which is 'normal' for active 15-25 year olds)?

This is pretty key to the logic we are all following ... any commments?!

 

[Anonymous]

Hi,

Now, here's an interesting one... I have tried for a while now to find out where the 'accepted' ranges for BG come from... diabetes nurses and consultants have no clue (ask them)... there is very little available research (try Medline..)... the one epidemiological study I have been able to trace (which my consultant lached on to, whether accurately or not, as the one which gives 'definitive' normal BG levels for the UK population at least) gives some interesting figures. For example, a 'normal' resting BG is 14.7 for women over 50... so, why would any of us aim for a resting level of between 3-5 (which is 'normal' for active 15-25 year olds)?

This is pretty key to the logic we are all following ... any commments?!

The NICE guidelines don't seem to say whether pre or postprandial tests should be before or after exercise. I would have thought that a fasting test should be done before any vigorous exercise, walking the dog, jogging etc. and the same should go for post-prandial (not very practical!). When I had my original bG tolerance test I had to sit quietly for 2 hours after drinking the Lucozade, presumably to minimise the burn-up of glucose. People who have set personal upper limits may be tempted to exercise first to help ensure they get the reading they want.