At what BG level does damage start to occur ??

[Katmandu]

I know normal BG levels are 70-110, but at what BG level does REAL nerve/vessel damage begin ?? :confused:

[Ronin]

Katmandu!

From everything I've read damage begins at sustained levels in excess of 180 mg/dl. The key word being "sustained."

[wiseguy]

Some studies, like this one (http://www.phlaunt.com/diabetes/14045678.php), suggest that post meal BG levels of over 140 and fasting levels of over 100 cause permanent organ damage.

[DeusXM]

Chicken and egg. The surveys that show FBGs over 100 mg/dl are related to beta cell death don't distinguish between whether the cell death is caused by the high BG or that the high BG is called by the cell death.

The DCCT still stands as the definitive, most extensive study done into the effects of BG on the rest of the body, and the conclusions from that were that patients with A1Cs below 7% significantly reduced their risk of organ damage and that A1Cs below 6.5% saw diminished returns because once you get below 6.5%, complications are essentially eliminated.

[slipperyelm]

I was having painful neuropathy in feet when my average was 120. :( This is an average usually considered decent control. I still had full sensation to pressure and irritants on my feet, but sensation of cold was exaggerated and painful, I had numbness, a feeling as if a string was tied around the base of one toe, and spontaneous pain that was unrelated to environmental stimuli.

[LancetChick]

The DCCT still stands as the definitive, most extensive study done into the effects of BG on the rest of the body, and the conclusions from that were that patients with A1Cs below 7% significantly reduced their risk of organ damage and that A1Cs below 6.5% saw diminished returns because once you get below 6.5%, complications are essentially eliminated.

Except that they weren't able to include a study of people with A1c's of 6 or less because the subjects were unable to maintain A1c's that low without significant hypoglycemic episodes. That was before testing 10+ times a day became fashionable and before modern insulins, however, so I think a new trial is definitely in order. I got retinopathy and frozen shoulder with average blood sugars of <150 (8.3mm), and reversed that by lowering my average blood sugar to a little over 100 (5.5mm), so I don't trust blood sugars of 150, or even 120.

[stech1]

This is a question that also concerns me. I was just dx'd with type II 4 days ago and have started metaformin 500mg 2x's daily... my BG test have averaged around 280 everytime I've checked it... my doctor wants to see me in 30 days.. but that seems like a long time to go if it doesn't go down significantly. Thankfully, some here have said that it takes a long time before significant damage is done. Unfortunately, we don't know how long I've had it.

[JediSkipdogg]

I got retinopathy...

You can run 300 all the time and still not have retinopathy or any chances of getting it. The #1 cause of diabetes retinopathy is highly fluctuating BGs. That is why recent research is now showing it's safer to run higher than low and bounce alot. However, only since CGMS has been out can standard deviation truely be measured.

I wholeheartedly think a new study like the DCCT is needed however don't see one ever being conducted again soon. 1400 patients were used over a 10 year period (1983-1993). It is thought that the study cost an average of $6000 per patient per year. That equates to 84 million dollars that the National Institutes of Health funded all for no real immediate gain to them.

For that study to be conducted today with the same exact time frame and patient size, it would cost around 130 million. However, today, a much larger group size would be used as finding people to last 10 years in a study is harder today than it was 20 years ago.

I would love to see a study funded and would love to participate in one for such a huge objective. However, I don't see anyone willing to freely fund one anytime soon especially since health care and research costs are increasing at an exponential rate.

[JediSkipdogg]

This is a question that also concerns me. I was just dx'd with type II 4 days ago and have started metaformin 500mg 2x's daily... my BG test have averaged around 280 everytime I've checked it... my doctor wants to see me in 30 days.. but that seems like a long time to go if it doesn't go down significantly. Thankfully, some here have said that it takes a long time before significant damage is done. Unfortunately, we don't know how long I've had it.

With metformin it takes a while to fully start working and once you go off it (which you shouldn't) then it takes a while to notice those effects as well. Personally, I don't think running high for a short period of time will harm anyone. I think it's when they run high (and I'm talking 250+) over 5 years that significant harm is done.

Again, that's just my opinion as no official research has been conducted recently on what does limit complications and what is pushing the boundaries too much.

[cheryl]

So when does the damage start if you ran bg's in the 250's over 5 years....I did for the first ummmmmmm about 6 years or so, then I had a1c's in the 8's and now in the 6's for the past 5 or 6 months, so when does it start.....am patiently waiting for my impending death.....Sorry for the sarcasim, everyone is different, some people have been in high a1c's and lived for 30 or 40 years before any complications set in, some can barely do it in 2......

Let's just say it depends on the person, and pray your not one of them....

Cheryl

[Harold]

Just to throw a little wood on the fire. Depends on which type you have. Type 1's seem to be able to run a little higher more often than type 2's without developing complications. Type 2's seem to be at an increased risk, compared to type 1's, to developing Syndrome X because of the differences in metabolisms. With Syndrome X your chances of developing cardiovascular and neuropathy complications increases significantly. The AACE in reviewing the DCCT and UKPD studies report chances of developing retinopathy increases significantly with A1c's between 6.2 and 7.5. Reading between the lines it means some will develop it with A1c's below 6.2 and above 7.5, bit most between the values. Your best bet is to try to keep your A1c's below 6. Know you were asking about BG's, but BG's go up and down and so far it seems to be more of an average thing. Like the others said we are due for another study. I know a fellow worker that is in a long term study, but what we really need is a long term study of people constantly connected to CGM devices to really be able to answer your question. You can probably expect it to take another 25 to 30 years before one of them has been done.

[someone]

However, only since CGMS has been out can standard deviation truely be measured.

My CGMS says that my standard deviation for 31 days is 46.4. Think that could have a detrimental effect?

[Cyborg]

You can run 300 all the time and still not have retinopathy or any chances of getting it. The #1 cause of diabetes retinopathy is highly fluctuating BGs.

Where did this come from? I don't agree...

Certain cells in the eyes and in the kidneys do not require insulin to absorb glucose. This imbalance of glucose and associated effects in these organs cause the problem.

I will accept that fluctuating bg values can perhaps makes things worse, but to say a constant bg of 300 will not increase your chances of retinopathy is wrong, IMO.

[JediSkipdogg]

Where did this come from? I don't agree...

Certain cells in the eyes and in the kidneys do not require insulin to absorb glucose. This imbalance of glucose and associated effects in these organs cause the problem.

I will accept that fluctuating bg values can perhaps makes things worse, but to say a constant bg of 300 will not increase your chances of retinopathy is wrong, IMO.

In the eyes, the cause of diabetes retinopathy is the swelling of the vessels in the eyes. They can expand to larger than normal without a problem, however, the problem is constant expanding and shrinking over time. This puts alot of stress on the vessels in the eye eventually causing them to burst. Constantly running high, and steady, allows the vessels in the eye to "form" to the expanded size.

As for the kidney, that's a different organ, so a different situation.

[Funnygrl]

I've heard over 130. But if you think about it, a normal bg is really something like 90, except maybe right after huge meals, but even then, healthy people get a 1st phase insulin release those of use her are insulin dependent don't.

[murphysl]

Maybe I'm the only one, but I don't like to go too far in the other direction too often either
Hypoglycaemia exacerbates ischaemic retinal injury in rats -- Casson et al. 88 (6): 816 -- British Journal of Ophthalmology (http://bjo.bmj.com/cgi/content/abstract/88/6/816)


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[lottadata]

The DCCT still stands as the definitive, most extensive study done into the effects of BG on the rest of the body, and the conclusions from that were that patients with A1Cs below 7% significantly reduced their risk of organ damage and that A1Cs below 6.5% saw diminished returns because once you get below 6.5%, complications are essentially eliminated.

The DCCT involved only Type 1s. When it was duplicated in the UKPDS with Type 2s, they found far more complications at the same 7% A1c.

That's probably because Type 1s and Type 2s have different patterns of high blood sugars, which yield the same A1c, but the Type 2s are very high much more of the time--typically with FBGs well over 160 where Type 1s oscillate up and down.

Type 1s are dealing with such a different situation, that when they and Type 2s engage in debate it is not productive.

You also have to remember that at diagnosis, the typical type 2 already HAS diabetic complications that Type 1s know take 10-20 years to arise, including neuropathy (almost half of all Type 2s at diagnosis), kidney changes, and early retinopathy.

--Jenny
What They Don't Tell You About Diabetes (http://www.phlaunt.com/diabetes)
Diabetes Update (http://diabetesupdate.blogspot.com) Healthcentral.com Top 10 Blog

[slipperyelm]

Hi again, I'm the one who said she had some neuropathy even when my A1C indicated average BGs of 120.

Yesterday I was paging through the famous Richard Bernstein book, Diabetes Solution when I came across his statement that sustained levels of 120 (exactly my level at the time!) have been known to cause, uh, I think he said "diabetic complications." This is the first time I have seen anyone say anything to confirm that what I said about my neuropathy could possibly be true.

[lottadata]

Neuropathy appears to develop when 2 Hour GTT values are over 140, according to two different well-conducted studies I have cited on my web site.

"Average blood sugar" and A1c also break down for a lot of us when we have A1cs in the 5% range. I assume this because the formula to relate the two was calculated from the DCCT data where testing was limited and most participants had much higher A1cs.

No way is my "Average" anywhere near what the formula says it is. I've tested a lot and have a very good idea what my blood sugars are doing, but the A1c is always about .4% higher than the formula relating the two would suggest.

I heard that next year they're releasing a new relationship between A1c and mean glucose based on CGMS studies. I hope it is more helpful!

[Original7]

repeated levels of 150 or higher..

[Original7]

Repeated levels of 150 or higher..also repeated levels of 40 or lower...also rapid swings cause more damage than continuous high or low levels.

[Janlaton]

My doc said it was impossible to say. Just best to work for the best control possible and pray that I did not have damage. That's what I did for years and it took 4 years to figure out I had a diabetic related problem when I started blacking out. So like most other stuff related to diabetes do not try to pin point it. That's just to specific!

[fgummett]

Yes... I tend to agree... it is kind of a moot point. Even someone with great numbers can still get complications. :( All we can really do is try to do the best we can and cross everything :)

[Janlaton]

Don't forget to dot the "i"s. I had to get into the 2% of people who have neuropathy not in the hands or feet. Go figure. But then the more I hear about the pain in the feet the more I can tolerate my heart missing beats now and then now that we know why!

[Original7]

A1C's are an Extremely rough measure of an average over three months... A lot can happen in three months to a body... Look at a normal person and the levels in thier body, each time you go above or below this range, there is some damage somewhere. It adds up over time and the results are different for each person with obviously some similarities among many. When your body is in normal range, you are normal and actually not receivng any diabetic damage. It's very difficult to do, but if you could NEVER run over 140 and NEVER go below 50, you won't have any complications.

A1C's are a big thing on this site.. I have to say maybe a little too much.. I personally think that the real damage is cause by the swings. This, I think is why you can have great A1C's and have damage..

[wzlcin]

I got retinopathy and frozen shoulder with average blood sugars of <150...

What's a frozen shoulder?

[Original7]

The DCCT involved only Type 1s. When it was duplicated in the UKPDS with Type 2s, they found far more complications at the same 7% A1c.

That's probably because Type 1s and Type 2s have different patterns of high blood sugars, which yield the same A1c, but the Type 2s are very high much more of the time--typically with FBGs well over 160 where Type 1s oscillate up and down.

Type 1s are dealing with such a different situation, that when they and Type 2s engage in debate it is not productive.

You also have to remember that at diagnosis, the typical type 2 already HAS diabetic complications that Type 1s know take 10-20 years to arise, including neuropathy (almost half of all Type 2s at diagnosis), kidney changes, and early retinopathy.

--Jenny
What They Don't Tell You About Diabetes (http://www.phlaunt.com/diabetes)
Diabetes Update (http://diabetesupdate.blogspot.com) Healthcentral.com Top 10 Blog

Good point, but don't totally dis the DCCT findings for Type II's because it has proven some complications can be reversed with lower and tighter control.. This wasn't known before 1993.

[Injecto]

Keep it nice and simple. The answer is if BGs are over 6mmol (108). Your body tries to keep you under that naturally. If you ran at 6.9 (124) for months, you'd have symptoms, hence it's causing problems. Anything higher is worse.