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Type 1 glucose levels

HannahBananaBee

Newbie
Messages
1
Location
Kumamoto, Japan
Type of diabetes
Type 1
Treatment type
Insulin
I have a question. I'm American, but living in Japan. I was diagnosed about a month ago, by a Japanese doctor. He has told me that a "healthy" glucose level is between 40 and 80. But from what I'm seeing online, 70-110 is the recommended level. At least, according to the American Diabetes Association. And I have had crashes at around 80. Is there a worldwide standard? I don't really understand why it would be so different for different countries. I mean, yeah Japanese and Americans have different body sizes, but when it comes down to it, don't both process sugar the same? I'm just kinda confused I guess haha. Thanks in advance for any advice/comments.
 
I strongly recommend you get hold of a copy of Dr Bernstein's "Diabetes Solution". This is THE classic work on diabetes by a man who has survived diabetes from diagnosis at the age of 12 to his present healthy age of 83 and who invented the idea of home bg testing. You can also find a lot of material on his site, including chapters from his book and many brief videos. He also still conducts question and answer sessions once a month which can be downloaded. His ideal is a steady bg of 84, but in treating newly diagnosed T1s he says he sometimes sets a higher bg as goal temporarily to avoid hypos. He, and many researchers, consider that the ADA targets are dangerously high.

http://www.diabetes-book.com/book/
 
TID 51 years on insulin in Oz. Hi there and welcome. I am from Australia but enjoy this forum. This is not to be taken as medical advice or opinion.
To help us help you can you verify somethings please. ?
I assume you are prescribed insulin and that you have a glucose meter which reads your blood sugars in (mg/dl). ?
Can you briefly describe what your 'crashes' are like and what you do to remedy them? I am assuming they are hypo's or low blood sugar crashes which you remedy by taking a sweet drink, sugary lolly etc?
Do you know whether your doctor, in giving you the 40 to 80 range, was talking about fasting ( nothing to eat for 12 hours before hand) blood tests in mg/dl) ? OR before meal blood sugar range?
So I am assuming ADA is saying 70 -110 mg/dL ? ( = about 3.8 - 6.1 mmol/l . for recommended before meals blood sugar for TID. ( Type 1 Diabetes)
The recommended range for before meals blood sugar in type 1 diabetes in UK is 3.9 to 6 mmol/l = 72 - 99 mg/dl) ) Diabetes .co.uk) ( Diabetes Australia 4 to 6 mmol/l)
Your doctor's quote of 40 to 80 mg/dl (= about 2.2 to 4.4 mmol/l UK) is very low compared to the the UK recommended figures.
I tend to experience low blood sugar symptoms when I reach levels of about 3.3 mmol/l = 60 mg/dl)or less, unless my blood sugar is falling rapidly and then possibly from 5 ish mmol/l ( 90ish mg/dl) downward. At a level of 2.2 mmol/l (40 mg/dl) I have been confused, disorientated and in need of help with finding and taking glucose.
So, on the basis that the above assumptions are correct, it would seem wise to discuss your concerns with your doctor including the 'crashes' at the 80 mg/dl mark. Again please verify the above assumptions before seeing your doctor and also discussing the 'crashes'. Best Wishes. Enjoy the ancient Japanese art of kite making. I believe it is becoming rare.
PS You may have come across HBA1C - a venous blood measurement or perhaps a finger prick one nowadays which measures the average level of blood sugars over the past 3 months. In US it is usually expressed as a %, the ideal for TID being less than 7 %, but usually > 6%. Because of the similar numerical values to blood sugars I note that this site tends to use a newer scale for HBA1C ( i think the site has a reference to it). HBA1c of 7 = new scale 53, 6 = new scale 42. I imagine with using mg/dl you would tend to stay with % readings.
 
HannahBananaBee said:
He has told me that a "healthy" glucose level is between 40 and 80.
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Whoah, if he's talking about levels from a bg meter test, he is dangerously wrong.

Anything below 72 mg/dl, (or 4 in mmol/l which we use here in the UK and elsewhere) is regarded as hypoglycaemia because studies show that that is the level at which, as a general rule, most people's autonomic systems, which manage bodily processes behind the scenes, start telling the liver to release stored glucose to keep bg levels in range.

If you were to follow his advice and go down to 40 (2.2 in our money), that would be a bad place for a T1 to be. Your autonomic systems would have pushed out so much adrenalin that you'd be a quivering sweaty wreck, and the brain would be so starved of glucose that you'd feel like you were on a bad LSD trip. It can all be sorted quite easily though with some glucose.

If he's talking about your hba1c level, which is a measure of your average glucose levels over the last 2 to 3 months, a test which is done in hospital, and is measured in various ways, one of which is mmol/mol, a range of 30 to 60 is in the "green zone", although most docs will suggest around 40 to 50 to provide a bit of leeway against hypos.
 
I love you, and sorry to hear of your situation, as I am a recipient victim as I have voiced on this forum over the past weeks, regards the seriousness and care concern I have that cut off levels are aribitrary set in place yet more so differ worldwide.
I have given opinion and has sadly not been welcomed by some, that the Experts committes have a role responsibility to address this situation as you and I and many others, in wonderment and confused, that a cut off is decided with support of clinical and medical evidence, for finger testing and A1C that final cut off number, is then strictly adhered to worldwide. that will solve the problems of concerns anxiety as yourself within, and I labelled Diabetic Spain, but in New Zealand, Pre Diabetic, both diagnoses given for the same A1C result, this is a crazy situation to be in place. My wonderment is why is there not more people actually seeing this to assist people as yourself, myself and other. who is right or wrong until this is addressed Japan is not wrong as they follow their criteria guidelines, America follow theres to so both right, but ultimately, the two different sets of cut offs should not be in place, and this is why the system, experts have to address this to have the same cut offs worldwide in best interests of those struggling with diabetes, to save confusion. Your raising this, hopefully will indicate give the light that this is a topic issue that has to change for the better. One can appreciate your confusion, as I have been confused for a long time too and furious and frustrated along with that confusion.
 
Hello good info and I am from Oz too, and although resided New Zealand, but now here in Mallorca, not an easy situation,
my A1C result here is viewed diabetic, whereas in New Zealand the same result if viewed under their criterias of diagnosing as prediabetes. This is not a good situation, I have to say, New Zealand overall aproach and way they explain why their cut offs which is often, not agreed to by other countries, are for beneficial purposes to patients, overall, a situation one is victim bewtween two countries should not exist, there should be no variations, and the system should address this the world follows one strict chosen cut off A1C finger testing, backed by clinical and medical evidence for that chosen figure. Whether that will ever happen I doubt it sadly for many.

Hello Australia, miss you. Goodo post lots of info.
 
Alexandra100 said:
This is THE classic work on diabetes
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I think it is only fair to point out to the OP, who is newly dx'd, that the book is merely A work on diabetes, not "THE classic work" on the subject.

Many rightly take issue with the extremes it goes to and manage their T1 perfectly well.

Dx is a difficult and confusing time. Coming to terms with the need for lifelong injections is enough to come to terms with, so I don't think it's helpful to refer newbies to a book which dictates in far too strident terms that they should now more or less rule out an entire food group.

Presenting it as a "classic" work gives it an authority which it does not deserve and is likely to confuse newly dx'd about the options open to them.
 
I didn't mean it was the Bible! I do agree that it may seem too demanding to someone at the start of their diabetes journey. But I would maintain that it is at leas A classic work on diabetes. Do you have any others to propose? For T2s Jenny Ruhl offers a gentler introduction to the subject, but Dr B is far more relevant to T1s (as well as T2s).
 
pollensa said:
cut off levels are aribitrary
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Yes, they certainly are! But what counts is not really the cutoff levels, except insofar as they affect supply of medicines or driving licenses and other practical matters. What counts is the bg readings we are seeing on our meters, particularly before and after meals. Complications can start to set in long before any country would consider the person even pre-diabetic. Each of us has to decide our own compromise between the "normal" bgs that would protect us from all complications and the dietary restrictions and meds that might get us there. Personally I am prepared to eat very low carb, take a high dose of Metformin, and if I could get hold of insulin I would probably take that too, in order to get my bgs as low as possible. Other people will make different decisions.
 
I wonder if these recommendations that vary depending on country differ due to cultural lifestyle and average physique, or even ethnic differences? Japan has a very different culinary culture from America as well as the UK, and people are on average much smaller/thinner.
 
I think the UK follows the WHO recommendations, whereas many countries will follow the American Diabetes Association.
 
Alexandra100 said:
I think the UK follows the WHO recommendations, whereas many countries will follow the American Diabetes Association.
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Yes, I think this is correct to, and other countries somewhere in between, even the ADA cannot agree between themselves the committee and endos on what should be the cut offs, that just adds to more confusion for everyone, they say it left in hand of doctors to decide if they decide to go with the cut off ADA or Endos? good luck patient.

The Who at one state on their website recommendation No.7 stated "currently A1C is not considered a suitable diagnostic test for diabetes or intermediate hyperglycemia not reliable marker. Taking all of these considerations into account the Group Concluded that the role of A1c in the diagnosis of diabetes and intermediate hyperglycemia is not established and that it could not be recommended as a diagnostic test at this time. "

They have partially changed their stance on this, but indicates something not recommended reliable, then is reliable is not a black and white situation, not easy is it for us all inbetween what is what is not reliable, this number, that number I think time to have good slurp of very dry spanish vino,and be a little naughty.
 
pollensa said:
reliable is not a black and white situation, not easy is it for us all inbetween what is what is not reliable,
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Pollensa, if you wanted something reliable you should not have picked diabetes. A1c tests are unreliable, finger prick home tests are unreliable, GP and even endocrinologist advice is unreliable. Official standards and cutoffs are unreliable. Even stomach emptying and reactions to insulin are unreliable.

Of course if you wanted something character forming, training patients to do our own research, make our own decisions and stand up to authority (aka be bl**dy minded) diabetes was a pretty good choice.
 
Alexandra100 said:
Do you have any others to propose?
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Think Like a Pancreas by Gary Scheiner is a good one.

For those of us with cgm, Sugar Surfing by Stephen Ponder and Beyond Fingersticks by William Lee Dubois are helpful.

They're all T1, GS and SP are also endos, and WLD is a dsn, so they've all dealt with it personally and professionally.

I think they are less emphatic about things than Bernstein and give T1s more options than he does. SP has a chapter on how to insulin-stack for burritos, which would probably have Dr B fainting!

I accept that moderating carb intake is a good line - I do it myself, most meals are around 50 to 80g (although many would say that's too much) - but he just goes too far.

He's a product of his background. Had complications because of the primitive treatment methods in his youth, recovered because of being able to test and modify diet.

What I feel he's missing is that in this day and age, newly dx'd have from the start modern bg testing methods, better insulins, some have cgm, so it's perfectly possible to keep an eye on things from day one in a way which he wasn't able to, figure out which carb/bolus combinations work to stay in range, without ruling out an entire macro group.

There's been quite a few posts on this site by T1s who've gone down the Bernstein route. But they've then come back after a few months to say they actually would like to eat carbs after all. We're not talking crazy amounts here, not sugared popcorn at the movies, they just want to nip in to a local Italian cafe and have a 50g panini. Yet they feel guilty about it, because Bernstein says no. Even though a 50g panini with a bit of careful pre-bolusing is perfectly manageable with modern methods.

His book has a large section at the start with quotes from clients, enthusing about his methods. I'd like to ask them how they feel about doing such a restrictive diet for decades.
 
Alexandra100 said:
Of course if you wanted something character forming, training patients to do our own research, make our own decisions and stand up to authority (aka be bl**dy minded) diabetes was a pretty good choice.
Click to expand...


On that theme, here's a quote from Elliot P Joslin, written in 1935. He was one of the first doctors to realise diabetes is a self-treated condition and he played a big part in encouraging docs to hand over control to patients. He left a legacy in the Joslin Centres in America.

"I must say that I do admire the backbone and the brains of the average diabetic and I truly believe on the whole they are superior to the common run of people and therefore their good qualities merit cultivation. Second, I think they are less apt to drink, far less likely to have syphilis or gonorrhea, and distinctly less likely to have, what us anathema to me, 'nervous prostrations and nerves'."
 
Hi, I live in uk but originally from Japan. Normal blood sugar range used in Japan is similar/same to the one used in uk or US. So this sounds like a case of the doctor speaking poor English.
Less than 70mg/dL is considered hypo in Japan.
 
pollensa said:
This is not a good situation, I have to say, New Zealand overall aproach and way they explain why their cut offs which is often, not agreed to by other countries,
Click to expand...

Just my personal opinion here as a person with T2 not a health professional or scientist... I find the NZ guidelines to be quite sensible and realistic, and they seem to align well with NZ culture and lifestyles. If another country doesn't agree with the NZ guidelines, that's an issue for that country. It doesn't affect me. When migrating from one country to another, there will always be adjustments a person has to make between different ways of doing things, in all areas of life.

Each country is a democracy, with the public having their say through elections that affect the laws and even the health guidelines that get made. I think it would be anti-democratic if the citizens of a country lost control and had decisions made for them by other countries. We Kiwis are a feisty, independent bunch.
 
You make some very good points. However even today by no means everyone is going to be diagnosed early, and certainly not necessarily before complications have set in and made things - well - complicated!

In my case I only found out last summer that for years my A1c had been rising, from 37 to 40 to 41, at which point the practice nurse but not my GP thought it was worth mentioning to me. (Of course in the UK an A1c of 41 is not even considered pre-diabetes.) By that time I had accumulated damage to my vagal nerve leading to AF, reflux, lower back problems, a small ulcer and gastroparesis (delayed stomach emptying). (I dread to think what other harm has already been done.) As long as my gastroparesis persists I would not be able to bolus before meals, so my strategy is to follow Dr B's low carb plan in the hope of eventually curing it. I may be engaged in a race to heal my gastroparesis before my LADA honeymoon ends. And of course I am hoping that keeping my bgs low will help prolong that honeymoon. Time will tell. At worst, even if my efforts to preserve my beta cells are doomed to fail, every low carb low bg day is one less day I accumulate complications.
 
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