Minimum Blood Glucose Levels?

[lucylocket61]

Why arent Type 2 blood glucose level targets 5.5 24/7 like the levels of non-Diabetics? :crazy:

 

[Anonymous]

I thought the normal range was from 4 to 7.9?

 

[Grazer]

That's right - the average normal non-diabetics can go to 7.8 two hours after eating a normal carby meal. Some will go higher, some will be lower. Trying to aim for 5.5 24/7 would be step too far, and isn't really necessary anyway.

 

[Anonymous]

That's right - the average normal non-diabetics can go to 7.8 two hours after eating a normal carby meal. Some will go higher, some will be lower. Trying to aim for 5.5 24/7 would be step too far, and isn't really necessary anyway.

Bum. I was a point out. At least I didn`t look up the answer. I am learning!

 

[Grazer]

That's right - the average normal non-diabetics can go to 7.8 two hours after eating a normal carby meal. Some will go higher, some will be lower. Trying to aim for 5.5 24/7 would be step too far, and isn't really necessary anyway.

Bum. I was a point out. At least I didn`t look up the answer. I am learning!

:lol: 7.8 is only the AVERAGE person - 7.9 is probably right for loads! :thumbup:

 

[xyzzy]

Grazer is correct. You are confusing what is possible with what really happens in the real world. Yes Beta cells do begin to die off at levels greater than 5.6 if read the study I think you're referring to. However the rate of attrition in my mind must be very slow as otherwise a far greater proportion of the non diabetic population who quite regularly exceed 5.5 would be diabetic as well. Measured in terms of relative risks its far more likely you're going to peg it from some other unrelated cause than ending up two hours after eating above 5.5 but below 7.8. Rising fasting BG levels are also a normal part of ageing so the older you get the higher your HbA1c regarless of what you eat.

The key target is 7.8 as exceeding that screws your eyes and your feet and other stuff, a far more risky and immediate consequence.

To be even more blunt a Type 1 or Type 2 who has lost all their beta cells anyway maybe doesn't have to worry about 5.5 as they can still survive quite happily with insulin BUT the 7.8 target is still applicable to them as well so again another reason 7.8 is more important.

It is fine to aim for non diabetic BG levels but maybe think of it it in the following way as it is a far more positive approach than worrying you are going over 5.6.

7.8 is not only the danger value but is the level that 100% of average non diabetics get after 2 hours. So to be classified as an average non diabetic that's all you need do. If you don't do that then yes you are not a non diabetic. So loads of those average non diabetics regularly exceed 5.6 in fact its around 25% of the average non diabetic population.

If you want to aim higher than that then maybe go for 6.5 as that's the level 19 out of 20 non diabetics get so 95% of average non diabetics get to 6.5 after 2 hours. The other 5% are the ones who can manage 7.8

Yes if you CAN you may want to aim for 5.5. At 5.5 you are at the level that ONLY 3 out of 4 or 75% of the average population can achieve and I suspect that figure is actually a lot less if those average people eat the classic carb heavy diets that people do today.

So its a pretty **** hard thing to do especially if you're not taking any meds and are overweight or newly diagnosed and have a load of insulin resistance to shift so don't expect it to happen just within a few weeks of going ULC .

In the end you MAY get there with no meds as people like Hana have done just that. However consider those T2's (or 1.5's or 1's) where it isn't all insulin resistance and has for whatever reason has progressed to a loss of all or most of their pancreatic function. In those cases you may never be able to hit 5.5 without either opting for meds or opting for insulin. In my case I'm exactly like that at the moment. Yes I post averages which are less than 5.5 but they are averages and I go above 5.5. I also take Metformin and all the other stuff I post about. Without them there is no way I'd post sub 5.5 averages. Maybe when I've lost a load more weight but who knows I may also not have enough pancreatic function to do sub 5.5's without medication.

 

[the_anticarb]

I have non diabetic friend, she's very healthy and does a lot of running so I'm pretty sure she's not even pre diabetic (could be wrong though) and I tested her after she'd just drunk a pint of fruit juice, for an experiment. She was 8.5 or so, but came down to the 4s within an hour or two. So I guess her pancreas is working! But may not have been able to cope with all that fruit juice straight away.
Incidentally it bugs me when fruit juice is billed as a healthy food, it may have lots of vitamins and things but it aint doing no one's blood sugar any good. I use it to get out of hypo-land, particularly really sweet stuff like pineapple, as it seems to work as well for me as lucozade.

 

[Sid Bonkers]

There have actually been very few studies done on non diabetic bg levels, I mean why would they? But one that I have seen showed that something like 70% of non diabetics can spend up to 40 minutes a day at up to 11 mmol/L.

I dont know where all this 7.8 stuff comes from and to be honest I would tend to ignore it all, I would guess it comes from an American site and has been averaged out from 140 mmol/dl which is the system used in the states but as we live in the UK (for the most part) it has no bearing on us.

The NICE recommendations are what are used in the UK and should be viewed as a minimum/maximum level so for T2's fasting 4 to 7 mmol/L and 2 hour postprandial no more than 8.5 mmol/L which frankly I would be horrified at but we must all set our own limits based on our own lifestyles.

I like to see a postprandial level around 6 to 6.5 but as I have already said it is a personal goal, many T2 diabetics live quite happily at levels greater than this without ever suffering complications. That said it would seem best to keep postprandial levels as low as is possible for the individual but setting some American limit seems odd to me and seems to confuse a lot of newly diagnosed members here, why cant we all use the same recommendations? 8.5 or 7.8 there both on the high side so why bother to use two systems????

 

[phoenix]

Lucy,
Normal glucose levels do rise and fall. Sometimes you will read suggestions that people without D never have spikes, never go above a very low level. It is unrealistic to stay below 5.5mmol/l all the time, even someone who has a very low HbA1c of 5% has an average blood glucose of 5.5mmol/l so at some time they will have had levels above that.


http://www.diabetes-symposium.org/index ... iew&id=322

This always looks to me like a tangle of coloured wool but is actually a chart showing the blood glucose readings for a group of young people without diabetes living in Denmark.(non obese, normal glucose readings etc). They wore a continuous monitor for 2 days. This is a device that can show the glucose changes almost as they happen. They ate their normal meals but no snacks. You can see that after all meals their glucose readings rose.. this is normal. A few (and we don't know that they ate) spiked to quite high levels considerably above . 140mg/dl (7.8mmol/dl)
You can also see that in the main their levels rose for some time above 5.5 (100mg/dl). On average they were above that level for 3.6 hours out of 24 but some of these young, non diabetics were above that 5.5mmol/l level for nearly 6 hours of the day.
Edit:
(NB after reading SId's post I better say that the readings are in mg/dl because that's presumably what they use in Denmark, I use those units in France as well, as do many other countries. It's just a different unit; like pounds and kilograms, you convert mg/dl to mmol/l as used in the UK by dividing by 18 )
double edit:
What I didn't finish off is to say that we have to aim for realistic targets. These will vary according to what type and stage of diabetes we have. Some people with T2 will have been diagnosed at an early stage and be able with lifestyle changes to attain levels that are within normal ranges. Some can do it without medication, some will need it to even approach those levels. What I don't think anyone should be doing is striving for levels below even those of a normal young person.

 

[Grazer]

There have actually been very few studies done on non diabetic bg levels, I mean why would they? But one that I have seen showed that something like 70% of non diabetics can spend up to 40 minutes a day at up to 11 mmol/L.

I dont know where all this 7.8 stuff comes from and to be honest I would tend to ignore it all, I would guess it comes from an American site and has been averaged out from 140 mmol/dl which is the system used in the states but as we live in the UK (for the most part) it has no bearing on us.

The NICE recommendations are what are used in the UK and should be viewed as a minimum/maximum level so for T2's fasting 4 to 7 mmol/L and 2 hour postprandial no more than 8.5 mmol/L which frankly I would be horrified at but we must all set our own limits based on our own lifestyles.

I like to see a postprandial level around 6 to 6.5 but as I have already said it is a personal goal, many T2 diabetics live quite happily at levels greater than this without ever suffering complications. That said it would seem best to keep postprandial levels as low as is possible for the individual but setting some American limit seems odd to me and seems to confuse a lot of newly diagnosed members here, why cant we all use the same recommendations? 8.5 or 7.8 there both on the high side so why bother to use two systems????

I think it's not about "bothering" with 2 sytems, it's just that we don't believe the NICE figures. The graph Phoenix shows comes from a lecture I read the notes from 18 months ago and was impressed with. Amongst the figures, you will see the "normal" 2 hour max for non-diabetics is about 140, 7.8 in our terms which is why some of us use it. It's also the average peak after an OGTT for non-diabetics. Prof Christianssen in this talk shows data from about 18000 subjects showing an increased death rate of 50% for subjects in a band starting at 140 (7.8) two hours post prandial, another reason why it's a reasonable figure to aim at rather than the "safe" (non-hypo) 8.5 figure NICE use. The 50% increase shouldn't be viewed with alarm - it means that if a normal person had an 8% chance of dying, it rose to !2% in that group. Also, the 50% is across the group which goes up to people with figures over 10, so the 8.5 would be a smaller %age risk. However, some of us like to stay in the no %age group which is sub 7.8 (although I suspect detailed examination would show a rise as 7.8 is approached)
This guy christianssen isn't a quack by the way. Very well regarded as an expert in his field and key speaker at the diabetes symposium.

 

[Sid Bonkers]

You seem to have totally missed the point of my post Grazer, and why so defensive have I ever referred to Prof Christianssen as a quack?

All I said was it is better to stick to one set of figures as there is enough confusion amongst the newly diagnosed already and as there is only a .7 mmol/L difference between the US recommendations and the UK ones why confuse things by quoting the US figures.

The NICE recommendations are what we have so lets work with what we've got. Read my post again if you think I agree with the NICE recommendations, or the US ones for that matter.

 

[Grazer]

Not defensive at all Sid. Agree we should stick to one set of figures. Just think it should be 7.8 rather than 8.5 for reasons given. And if 0.7 is the difference between problems or not, then that amount is important. Bit like saying "what's the difference between an HbA1c of 6.1 and 5.9 - it all counts.

 

[Sid Bonkers]

Not defensive at all Sid. Agree we should stick to one set of figures. Just think it should be 7.8 rather than 8.5 for reasons given. And if 0.7 is the difference between problems or not, then that amount is important. Bit like saying "what's the difference between an HbA1c of 6.1 and 5.9 - it all counts.

So who is saying that problems start at 8.5 and not 7.8? I dont understand your reluctance to use the NICE figures, as I've already stated both sets are too high IMO but that is not in question here, what is in question is why some people seem to want to confuse people by using US figures when everyone else doctors, diabetes nurses, hospitals, health professionals and most people on this forum are the UK figures :crazy:

 

[Grazer]

The Christianssen study I and Phoenix referred to says 7.8 and not 8.5. He's not from USA. Don't think it's confusing - NICE use a figure which I and others think is too high, so we use a lower one. I'm sure others use ones even lower. I do and you Imply you do. NICE use below 7 HbA1C as a target and no-one believes that. You're rightly proud of uour 5.4? Not confusing. If people want to use 8.5 it's up to them - still not confusing. You said you'd be horrified if you got 8.5, so why tell others it's ok?

 

[phoenix]

DUK the charity says quite rightly
There are many different opinions about the ideal range to aim for. As this is so individual to each person, the target levels must be agreed between the person and their diabetes team.

 

[xyzzy]

I think you'll find 8.5 is not originally a UK recommendation but what the UK adopted from the IDF (International Diabetes Federation) over 40 years ago. Even 40 years ago 8.5 was seen as on the "high" side of safe by many researchers at the time.

In 2007 the IDF updated their recommendation to 7.8 based on a range of new studies including the one Phoenix and Grazer mention as well as studies such as:

Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Singleton, JR Smith AG, Bromberg, MB Diabetes Care 24 (8) 1448-1453 2001,

The spectrum of neuropathy in diabetes and impaired glucose tolerance. C.J. Sumner, MD, S. Sheth, MBBS MPH, J.W. Griffin, MD, D.R. Cornblath, MD and M. Polydefkis, MD; Neurology 2003;60:108-111.

Value of the Oral Glucose Tolerance Test in the Evaluation of Chronic Idiopathic Axonal Polyneuropathy. Charlene Hoffman-Snyder; Benn E. Smith; Mark A. Ross; Jose Hernandez; E. Peter Bosch. Arch Neurol. 2006;63:1075-1079.

and others...

So just as in other aspects of diabetic care the UK is just lagging behind other countries.

 

[Unbeliever]

To most T"s it will all be totally irrevant anyhow. As they are not supposed to test all these figures will soon be meaningless, to the vast majority of diabeics.

At least they won't be depressed .

 

[xyzzy]

To most T"s it will all be totally irrevant anyhow. As they are not supposed to test all these figures will soon be meaningless, to the vast majority of diabeics.

At least they won't be depressed .

:clap:

 

[lucylocket61]

But it is relevant to me and my health. Unless you are being funny and I missed it?

 

[Defren]

But it is relevant to me and my health. Unless you are being funny and I missed it?

They are teasing Lucy