Is keeping on the low side wrong?

[davef]

A question for the gurus.

I'm aware of the risks of high BG and that to try avoid risks of complications that BG's need to be controlled.

I believe that have been managing my numbers well, my averages are:

14 day 94.7 Std. Dev: 0.76
30 day 96.4 Std. Dev: 0.91
60 day 97.3 Std. Dev: 0.96
90 day 97.7 Std. Dev: 1.02

This week I seem to be doing very well at keeping my numbers down. I have been keeping my FBG around 95 and in general I'm around 81-90, post prandial numbers have not gone above 120 :)

The last 3 evenings I have dropped to 64.8, 66.6 and 68.4. I feel fine at that level. So here's my question, I'm wondering if continuing to dip below 70 each evening poses at risks/problems for me?

[morrisma]

Dave,
I think the risk is in frequent hypos resulting in yo-yoing to much higher numbers. Not to mention the dangers inherent in a hypo. As long as that's not causing a bounce, alls great!

Your numbers are quite enviable! Time for you to get your own radio show: Get diabetes, control diabetes, get healthy as a result! :D
Mike

[fgummett]

I agree David... those number look great to me. So long as you have tested after a carb load to see how you cope... as in not going very high and then a reactive low I say, "keep up the good work!" :)

[fgummett]

If you check out the IDF Guidelines... (http://www.diabetesforums.com/forum/diabetes/28457-idf-guideline-management-postmeal.html) I posted recently they state,Large controlled clinical trials have demonstrated that intensive treatment of diabetes can significantly decrease the development and/or progression of microvascular complications of diabetes. Furthermore, intensive glycaemic control in people with type 1 diabetes or impaired glucose tolerance (IGT) lowers the risk for cardiovascular disease. There appears to be no glycaemic threshold for reduction of either microvascular or macrovascular complications; the lower the glycated haemoglobin (HbA1c), the lower the risk.

[Scrabblechick]

Wow, Dave! Your numbers are AMAZING! Any doc would be turning somersaults over those numbers! Good job! :)

[Evermont]

Your numbers look fantastic to me. If I were you, and my numbers starting looking "too good", I might talk to doc about cutting the Metformin dosage. Ramp up the diet and exercise if needed to compensate at first. Just keep doing what you're doing - maybe relax things just a bit if it helps you settle into a good long-term lifestyle. Hats off 2 U dude!

[MJB]

Your numbers look fantastic to me. If I were you, and my numbers starting looking "too good", I might talk to doc about cutting the Metformin dosage. Ramp up the diet and exercise if needed to compensate at first. Just keep doing what you're doing - maybe relax things just a bit if it helps you settle into a good long-term lifestyle. Hats off 2 U dude!

Ditto

When my numbers came down, very similar to yours, my doc reduced the Met to one 500mg daily.

[babySlon]

Hi

14 day 94.7 Std. Dev: 0.76
30 day 96.4 Std. Dev: 0.91
60 day 97.3 Std. Dev: 0.96
90 day 97.7 Std. Dev: 1.02

Those numbers - what do they mean?
is it a different way to calculate sugar?
my #s are 4.3-5.7 before/after

[xMenace]

The last 3 evenings I have dropped to 64.8, 66.6 and 68.4. I feel fine at that level. So here's my question, I'm wondering if continuing to dip below 70 each evening poses at risks/problems for me?

You appear not to be on insulin, so actually going hypo shouldn't be a concern. I don't know what the Enap is though.

Who made up this magic number 70 anyway? And meter variance says a 64 is equal to a 70 anyway.

Continue as you are I say.

[slipperyelm]

Hey, MJB, when your doctor lowered your metformin, were you then able to maintains such good numbers, or did they come up a little?

The units of measurement are different, babyslon, between how you measure and how davef is measuring. Most of the world uses millimoles per liter (mmol/L), while milligrams per deciliter (mg/dL) is the standard in the standard used in the U.S. (Gotta at least give USAers credit for not reporting in dry ounces per quart or something like that, as they do with everything nonscientific!)

Your numbers, 4.3-5.7 equal 77-102 (Wow! Excellent!) using the same system as Dave. Because there are so many USA people on this site, you will often see number like his posted. Just divide those numbers by 18 to see what they are equivalent to in the units you are familiar with. So davef's 97, for example, would equal a 5.4 to you.

[fgummett]

David has converted his numbers to mg/dl as used in the USA (and not many other places). But I believe he also uses mmol/l as you seem to do :) There is a converter available on this forum page. I see it over on the Right under, Site Navigation.

So David's average of :
94.7 mg/dl becomes 5.26 mmol/l
96.4 mg/dl becomes 5.36 mmol/l
...and so on.

[slipperyelm]

Oh yeah, I had to look up Enap, too. It's a heart med, something for left ventricular insufficiency?

Dave, you are in Ireland? How accomodating of you to post in mg/dL for us. They say "When in Rome, do as the Romans do," but on the internet, we're in Rome and everywhere else at the same time!

[davef]

Thanks all.

The Enap is for my slightly elevated BP.

I did post my numbers on the USA measurements, but I do meter in mmol/L as Frank and Slipperyelm have explained just divide by 18. At this stage I'm fairly bi-lingual and feel with the fact that so many members are in the USA it's probably more helpful for me to post numbers in mg/dL. Sometimes if I'm not lazy I'll post both formats.

Think I'll keep on keeping on and maybe next month if things are still going well I might ask Doctor about reducing Met to 500mg once a day, my inclination (could wrong) would be to take it at night to keep morning numbers in check.

[Kim_in_TN]

EXCELLENT numbers! I would lean towards decreasing meds as well. That is my goal if I can get my dedication back in tact! *hangs head in shame*

[davef]

Ok, a quick update, I dipped to an all time low of 59.4 mg/dL. (3.3 mmol/L) yesterday evening. That was a little too low for me, so it's something I will be watching more closely, may eat a few more carbs at lunch time but with the way things are going I'm hoping to reduce my meds next month at my next doctor visit :D

Thanks for all the replies.

[JadeMonkey]

I'd agree with most everyone here and say that the lower you can keep it without going hypo or feeling ill effects the better. Just make sure as your bg dips lower that you're really thinking about how you feel and making sure that you are doing what is best for your body. Unfortunately there is no perfect "magic" number we should all be at (or a perfect meter to know if we're there), we just have to discover what works for us.

-Jade

[davef]

Jade,

I feel that with my progress towards lower numbers, especially over the past week or so that I'm being very vigilant and I'm testing more often in the afternoon/evening.

Thanks for the advice.

[davef]

My Father was asking me on Friday about my numbers and when I showed him my chart for the week, he said "I don't think you have it at all", believe he may have a house near a river in Egypt! :D

Anyhow, it's official I still have diabetes ;) I treated/indulged myself on Saturday as I had great/low numbers all day FBG of 102 and then stayed between 75-85 all day. So had a take-away with FRIES for dinner, bang two hours after first bite I was "rewarded" with 178 :eek:

So have behaved myself since and numbers back to my new normal again, fasting below 103 and between 78-90 all day :D

[Hammer]

Anyhow, it's official I still have diabetes ;) I treated/indulged myself on Saturday as I had great/low numbers all day FBG of 102 and then stayed between 75-85 all day. So had a take-away with FRIES for dinner, bang two hours after first bite I was "rewarded" with 178 :eek:

So have behaved myself since and numbers back to my new normal again, fasting below 103 and between 78-90 all day :D

I think that we all do that....think we have low numbers for so long that maybe we can indulge, only to find out that we can't. My numbers were low for a while and I was curious what would happen if I indulged. I decided to take two Prandin tablets before I ate, even though I don't take Prandin anymore since I switched to Byetta. I sometimes take a Prandin or two before a meal if I think the meal might have a higher than normal spike.

So, feeling that I had the BG in control with the Byetta and the Prandin, I tried a meal from McDonald's. Well, I spiked to over 200 and it took me two days to get it back down to around 100. Now I know what I set out to find....no matter what medications I take, I still can't eat whatever I want and keep my numbers in check.;)

[Stacman]

Those are pretty impressive numbers that I'm sure a large percentage of forum members would love to have. Since those numbers are so low I'd convince the doctor to go off all diabetes meds altogether for 1-2 weeks to see if you're even a viable candidate of diabetes. I have to think you'll remain within the "so-called" ideal target range without meds. The date diagnosed could have been an abnormal sugar spike that elevated your levels. Perhaps you didn't fast well enough prior to the labs (we've all done that). Or even a host of other factors influencing the numbers.

[Real4]

Ok, a quick update, I dipped to an all time low of 59.4 mg/dL. (3.3 mmol/L) yesterday evening. That was a little too low for me, so it's something I will be watching more closely, may eat a few more carbs at lunch time but with the way things are going I'm hoping to reduce my meds next month at my next doctor visit :D

Thanks for all the replies.
It would be useful if you were more specific then just "evening" -
locate the reading in relation to the last meal and the carbs in that meal, AND to any exercise if that is relevant.

I suspect it is - you should NOT go low, just on metformin. But some non-insulin users will go low on exercise.

[Achilles]

Hi Dave,
Congratulations on your maintaining your great numbers. That is very impressive and some positive reinforcement for all of your efforts.

Would you mind briefly describing what is working for you diet and exercise wise? I'm hoping to get numbers like you too but I've only been less than 100 mg/dL twice in 5 weeks since I started all of this. Hopefully the metformin is just starting to set in for me.

Congrats again and best wishes if you can cut some of the Met out.

[matingara]

My Father was asking me on Friday about my numbers and when I showed him my chart for the week, he said "I don't think you have it at all", believe he may have a house near a river in Egypt! :D

Anyhow, it's official I still have diabetes ;) I treated/indulged myself on Saturday as I had great/low numbers all day FBG of 102 and then stayed between 75-85 all day. So had a take-away with FRIES for dinner, bang two hours after first bite I was "rewarded" with 178 :eek:

So have behaved myself since and numbers back to my new normal again, fasting below 103 and between 78-90 all day :D

DENIAL!!!!!!!!!!!!!!!!!!! Ha ha ha!!!

Look, i am going to start another thread about this - BUT.

My best friend (and his lovely wife) stayed with us this weekend. He is a GP with 30 years experience. He is one of the most intelligent and practical people I know. (Hence why he is a friend).

When we discussed my BGL control (which is similar to yours Dave) - he was most concerned that i was "erring on the tight side of BGL control".

He said that it isn't at all unusual for non-diabetics to shoot up to 180-200 mg/dl after meals. he said i was being far too hard on myself with my self imposed low carb regime and that with the numbers i was getting i should loosen up a bit.

over the weekend (while they were here) i indulged in things that i have avoided. i ate the occasional french frie or two. some small pieces of sourdough bread. small serves of ice cream. all in moderation. all as part of a very varied diet during the weekend.

my BGL was still very good even with these indulgences. i wonder whether we are being too hard on ourselves?

-- Joel.

[Lucinda]

Wow, Dave! Your numbers are soooooo good! How do you get your numbers so low? Has this always been the case for you? Have you lost a lot of weight with these numbers? Yes, lots of questions, I know...but, did I say, "WOW"!!! Those are some GREAT numbers!!!

I am just in this past week starting to feel and see the effects of the Metformin along with my efforts to eat right and move more. I started taking the Metformin about 31/2 weeks ago. I was diagnosed with type 2 this past January. My numbers are finally at about 140 first thing in the morning, and I am managing to keep the numbers around 115 to 125 during the day. I am excited to finally be seeing better numbers than the 180's and 220's that I was seeing. I am also FEELING SO MUCH BETTER!!! Thank God for that!!! I felt like I was a crazy woman when I had such high numbers. I don't feel sick this week!!!

Thanks for your ear, and good job to you!!! Cindy

[Chappo]

Hi Dave,
As far as I know and from what i've been told, there is a long-term risk of losing your hypo 'signs' by frequently running below ~4mmol/L or in your numbers around 72. Your body becomes accustomed to being lower, and you do not realise your hypo symptoms as you used to, and those signs/symptoms may change.

The major risk there is not being able to tell as earlier (or at all) when a hypo is imminent.

The same goes for the reverse: when running slightly higher for an extended amount of time, you may feel hypo, but your blood sugars are in normal target range.

But anyway, those are fantastic numbers!!! :)

[davef]

Now I know what I set out to find....no matter what medications I take, I still can't eat whatever I want and keep my numbers in check.;)

Yep, I reckon medication is only part of the equation and diet (not being on a diet) as in what you eat, is a huge part coupled with exercise. I knew I was overstepping the mark when I had the fries, it was a treat as much as an indulgence. I'm back on the straight and narrow now and very happy with myself.:)

Those are pretty impressive numbers that I'm sure a large percentage of forum members would love to have. Since those numbers are so low I'd convince the doctor to go off all diabetes meds altogether for 1-2 weeks to see if you're even a viable candidate of diabetes. I have to think you'll remain within the "so-called" ideal target range without meds. The date diagnosed could have been an abnormal sugar spike that elevated your levels. Perhaps you didn't fast well enough prior to the labs (we've all done that). Or even a host of other factors influencing the numbers.

Hi Stacman, I am hoping to reduce my dose of Metformin but want to have a good history of at least 3 weeks before I talk to my Doctor about a reduction. In time if I can manage with diet alone I'll be one happy camper! However, I know that I can't lose sight of the fact that if I achieve that I will be managing my diabetes with out meds, not that I won't have diabetes - that's a concept my Father seems to have difficulty grasping, so if it happens I'll just tell him I'm in remission ;)


It would be useful if you were more specific then just "evening" -
locate the reading in relation to the last meal and the carbs in that meal, AND to any exercise if that is relevant.

I suspect it is - you should NOT go low, just on metformin. But some non-insulin users will go low on exercise.

Real4, No the metformin alone will not cause me to go low, after all what metformin is doing is lowering my insulin resistance and so my body is making more effective use of the insulin I am producing. I have been really watching my carbs for the past while and feel this plays a part in my numbers. By evening, when I hit 3.3 it was 6.45pm, I had eaten a low carb lunch of sliced ham and two small pieces of wholemeal bread at 1.30pm and it followed driving home.


Would you mind briefly describing what is working for you diet and exercise wise? I'm hoping to get numbers like you too but I've only been less than 100 mg/dL twice in 5 weeks since I started all of this. Hopefully the metformin is just starting to set in for me.

Achilles, Stick with it, getting below 100 twice within 5 weeks of starting is great, well done :top: I just looked at my log and it took me 5 weeks to get below 100 once and really it took about 6 weeks to see the real effects of diet, exercise and the metformin combined.

In relation to what is working for me. I was very good on exercise for the first 8-10 weeks, then I got very busy, it was cold and I slacked on the exercise, I do need to get back walking (which is what I was doing) as I know by doing so I can "afford" a few more carbs. Mainly, I just being careful about eating .. I mentioned it earlier, but I don't consider myself to be "on a diet". I pretty much avoid things like white bread, rice, pasta and potatoes. I'm eating a small breakfast (most days) of slice of wholemeal bread, lunch varies but almost always includes 2 slices of wholemeal bread with something like a "cup-a-soup" or some sliced ham or mature cheddar cheese (I go easy on the cheese as I'm losing weight). Dinner is then meat with lots of veg, sometimes I'll have a potato waffle (which I seem to tolerate very well). I do a lot of things like chili, stir fry, fajitas, chicken. I'm certainly not skimping on calories. I have no idea if it has any bearing on things but I tend to use a fair bit of garlic and spices. Oh, lots of water to drink.

When we discussed my BGL control (which is similar to yours Dave) - he was most concerned that i was "erring on the tight side of BGL control".

He said that it isn't at all unusual for non-diabetics to shoot up to 180-200 mg/dl after meals. he said i was being far too hard on myself with my self imposed low carb regime and that with the numbers i was getting i should loosen up a bit.

over the weekend (while they were here) i indulged in things that i have avoided. i ate the occasional french frie or two. some small pieces of sourdough bread. small serves of ice cream. all in moderation. all as part of a very varied diet during the weekend.

my BGL was still very good even with these indulgences. i wonder whether we are being too hard on ourselves?

-- Joel.

Joel, I guess there are diabetics who frequently spike to 180-200 after meals, but I personally don't believe that is good control, I don't think it is being too hard in myself to keep below 140 2 hours after 1st bite.

I too have on special occasions indulged a little with things like bread, couple of french fries or some chocolate, for me it's keeping it occasional and in moderation, I didn't keep the fries in moderation last weekend as the results showed. I try to prepare for the indulgences by really watching my carbs in advance of indulging. I do allow myself a little more latitude at the weekend, and I'm stricter during the week, not every weekend though.

Wow, Dave! Your numbers are soooooo good! How do you get your numbers so low? Has this always been the case for you? Have you lost a lot of weight with these numbers? Yes, lots of questions, I know...but, did I say, "WOW"!!! Those are some GREAT numbers!!!

I am just in this past week starting to feel and see the effects of the Metformin along with my efforts to eat right and move more. I started taking the Metformin about 31/2 weeks ago. I was diagnosed with type 2 this past January. My numbers are finally at about 140 first thing in the morning, and I am managing to keep the numbers around 115 to 125 during the day. I am excited to finally be seeing better numbers than the 180's and 220's that I was seeing. I am also FEELING SO MUCH BETTER!!! Thank God for that!!! I felt like I was a crazy woman when I had such high numbers. I don't feel sick this week!!!

Thanks for your ear, and good job to you!!! Cindy

Cindy, Well done on your improving numbers, I know what you mean about feeling better for it. Yes I have lost weight, 50lbs so far and I reckon that has helped in lowering my numbers. You are really only just starting on the Metformin so, give it and yourself a little time. As I mentioned above it took 5 weeks for me to see a real improvement in numbers. Watching the carbs really helps me.


Hi Dave,
As far as I know and from what i've been told, there is a long-term risk of losing your hypo 'signs' by frequently running below ~4mmol/L or in your numbers around 72. Your body becomes accustomed to being lower, and you do not realise your hypo symptoms as you used to, and those signs/symptoms may change. The major risk there is not being able to tell as earlier (or at all) when a hypo is imminent.

The same goes for the reverse: when running slightly higher for an extended amount of time, you may feel hypo, but your blood sugars are in normal target range. But anyway, those are fantastic numbers!!! :)

As my numbers are lower over the past few weeks I am testing a little more towards the evening (4-6pm), as I would be happy to keep my numbers above 4mmol/L (72). I am a believer in testing so I am not purely relying on feeling low/high, that said I am at present fairly good at guessing before my test and being close to what the meter shows. But thanks for the advice.


Thanks for all the replies.

One of the things I didn't mention in answering the above questions, is something I feel has been an important factor in me gaining control and managing to get my numbers down ... that is DiabetesForums and the great advice, support and help I get from the people here. I have a guardian angel here and she has been really fantastic in helping and guiding me since joining, thanks L.

[ant hill]

Ok, a quick update, I dipped to an all time low of 59.4 mg/dL. (3.3 mmol/L) yesterday evening.

WHOA!!! David, Out of all things to be low is a no no!!! However being high for too long is not good ither and so the morrol of my argument is look at 6MMOL/L or 108 MG/DL and so the practice of mantaining that tight grip and so that's why I test so often.
As you're a type 2, You're are able to give your body some normal shock to what you can eat as for type 1's we have to think what to do before we eat and act appon it. ;)
That was a little too low for me, so it's something I will be watching more closely, may eat a few more carbs at lunch time but with the way things are going I'm hoping to reduce my meds next month at my next doctor visit :D
Appart from that, I wouldn't worry too much as I find your numbers very desireable. But whatch those lows David then you will live a long and happy life. ;)

[davef]

Peter,

Thanks for the kind words of support, you can always be relied on!

[Richard157]

Dave, the low side is Ok in my opinion if you watch it carefully and it does not cause you to become hypo too much of the time. Did you read pizzaman's posts while he was still allowed to post on DF? I have known pizzaman for two years and have read his posts on four different sites. He has had many, many hypos in order to keep his A1c low. His current A1c is 4.8. He thinks that he has great control, by his definition, and he thinks he will never have complications with eyes, kidneys, heart, etc. as long as he keeps on the low side. His problem is that all those terrible lows have affected his brain. I feel certain that he has suffered brain damage after 39 years of diabetes and his being on the low side with terrible hypos.

I have tests in the 60's and sometimes injthe 50's but I test 15 times per day and I am always aware of any oncoming lows. I don't consider an occasional test on the low side poor control as long as I take care of it before it becomes a real problem. My A1c is 5.7 and my doctor wants me to stay between 5.5 and 6.0. I have been able to do that for several years now.

Your numbers are sensational! Keep up the great work!

Richard

[Achilles]

[/QUOTE]
"Achilles, Stick with it, getting below 100 twice within 5 weeks of starting is great, well done :top: I just looked at my log and it took me 5 weeks to get below 100 once and really it took about 6 weeks to see the real effects of diet, exercise and the metformin combined.

In relation to what is working for me. I was very good on exercise for the first 8-10 weeks, then I got very busy, it was cold and I slacked on the exercise, I do need to get back walking (which is what I was doing) as I know by doing so I can "afford" a few more carbs. Mainly, I just being careful about eating .. I mentioned it earlier, but I don't consider myself to be "on a diet". I pretty much avoid things like white bread, rice, pasta and potatoes. I'm eating a small breakfast (most days) of slice of wholemeal bread, lunch varies but almost always includes 2 slices of wholemeal bread with something like a "cup-a-soup" or some sliced ham or mature cheddar cheese (I go easy on the cheese as I'm losing weight). Dinner is then meat with lots of veg, sometimes I'll have a potato waffle (which I seem to tolerate very well). I do a lot of things like chili, stir fry, fajitas, chicken. I'm certainly not skimping on calories. I have no idea if it has any bearing on things but I tend to use a fair bit of garlic and spices. Oh, lots of water to drink.

[/QUOTE]

David,
Thanks for the very detailed response. You got back with everybody too. Impressive and I have found you to be a great source of information on this forum.

I absolutely felt great today. I just knew I was "low"; tested at 95 when I got home today. So that is now 3 times in 5 weeks that I broke the 100 mark. Your sharing of your experience gives me confidence and even further support to continue on my path. It really is strange to feel "normal" again. This is how I used to feel I'm thinking before I got this D.

I've been pretty much been eating like you. Not really counting calories (within reason) but just watching the carbs.