Mayo Clinic on BG levels

[dbaratta]

This is just my opinion but I get the feeling that some people are disappointed in a BG that is around 140 2-hours post meal. I have researched this before but thought I would share the information from the Mayo Clinic on Fasting BG and post meal BG.


This week I would like to talk about the blood glucose target range. What should it be? A normal fasting blood glucose target range for an individual without diabetes is 70-100 milligrams per deciliter (mg/dL) or 3.9-5.6 millimoles per liter (mmol/L). The American Diabetes Association recommends a fasting plasma glucose level of 90-130 mg/dL (5.0-7.2 mmol/L) and after meals less than 180 mg/dL (10 mmol/L). The Mayo Clinic endocrinology department has 3 standardized blood glucose target ranges.

Fasting blood glucose targets:
Standard target 80-120 mg/dL (4.4-6.7 mmol/L)
Modified target 100-140 mg/dL (5.6-7.8 mmol/L)
Pregnancy target 60-100 mg/dL (3.3-5.6 mmol/L)

*Individuals with hypoglycemic unawareness (limited or no awareness of low blood glucose symptoms) are in the modified blood glucose target. Your healthcare provider may personalize your blood glucose target for specific medical conditions. Blood glucose targets should be in a healthy range to prevent diabetes complications, but also keep you safe from serious low blood glucoses.

Remember, blood glucose targets are targets. Diabetes is a balancing acting and blood glucoses will fluctuate; even sharpshooters don't hit the bull's-eye every time.

[Moonglo]

Thanks Poppy. I never would have thought to look at Mayo Clinic for diabetes guidelines. I can see why it would make sense that if one has problems with not knowing when their bg is too low, that individual would be better off to stay on the higher end of normal for safety reasons.

[matingara]

interesting input!

i had a post-dinner reading tonight of 162 (9.0) and i was very disappointed.

i like my BGL to be below 126 (7.0) at all times.

i aim to have my pre-meal bgl at between 72 and 90 (4.0 - 5.0).

i take an averagge of 7 readings per day - before and after each meal and before bed. my AVERAGE bgl at the moment is 103 (5.7). i am pleased with that.

i don't think i would be pleased if i used these mayo numbers...

:)

-- joel.

[Gangrel]

From being on this site off and on over the years, I have learned that there are those of us who are happy with sticking with the guidelines, and those who strive for near-normalcy.........

I have gotten into many debates over which way is "better", and have figured out that it's different strokes for differnt folks.....

For me, if i do a post meal test, and i'm 10.0 or lower, i'm happy to leave it as is. The sacrifices I would have to make in my life to be below 7 after a meal, for example, to me would diminish my lifestyle and make me resent this disease more then I might now.

But again, that's just me, and there's no right or wrong answers...... (as much as the internet thinks there is! lol)

[dbaratta]

Thanks Poppy. I never would have thought to look at Mayo Clinic for diabetes guidelines. I can see why it would make sense that if one has problems with not knowing when their bg is too low, that individual would be better off to stay on the higher end of normal for safety reasons.

That is true as long as it isn't too high. Doc told me better high than low......:eek:

[dbaratta]

interesting input!


i don't think i would be pleased if i used these mayo numbers...

:)

-- joel.

Well I was just putting it out there because some people feel as if their 120-140 readings are horrible. I mean if I stayed 120 constant I would be a happy camper. I have had fasting BG in the high 400's. Now that's scary. ;)

[plattb1]

Joslin Clinic's guidelines are similar:

Fasting 70-130
Before lunch, supper, snack 70-130
Two hours after meals <180
Bedtime 90-150

They also recommend an A1c of less than 7%.

But, American Association of Clinical Endocrinologists (AACE) has defined stricter blood glucose target goals of less than 110 mg/dl before a meal and less than 140 mg/dl two hours after the start of a meal.

[jillybean]

I am definitely disappointed with anything over 140 EVER, and would be disappointed with a reading of 140 at 2 hours post-meal as well. 140+ is the point at which the glucose in your system causes damage to your organs (or so I have read from multiple sources). I strive for normalcy, not "good for a diabetic."

[soso]

I have always strived for the lower numbers, been pretty successful too, but I can hear what Gangrel is saying. Lately I realize I am tired tired tired of it, I feel pretty close to burned out on it all and have considered relaxing my expectations somewhat. Then I see a higher number and freak out a little and it is back to the routine. I sometimes wonder if my body will survive but my brain will be fried.

[Gangrel]

Well, my thinking is, why strive for normalcy? Guess what? We're not normal. The day we were all diagnosed, we gave up whatever normal card we had in exchange for a diabetic card......

I have seen lots of people on this site over the years go crazy trying to achieve goals they shouldn't be reaching for. Is it good to have goals? Of course! But in my mind the goal of "normalcy" is long gone.

I aim for the targets that my medical professionals who are far smarter then I have said are ok, and go from there. Do I try to beat them? Why of course, I don't put a loaded gun to my head everyday and try to be an awful diabetic.....

But if i eat a good meal and decide to do a check after, and I'm 11 or 12, or even 15, I take a correction perhaps, and move on. I get beat up enough playing hockey, I don't need to do it to myself either......

[dbaratta]

Joslin Clinic's guidelines are similar:



But, American Association of Clinical Endocrinologists (AACE) has defined stricter blood glucose target goals of less than 110 mg/dl before a meal and less than 140 mg/dl two hours after the start of a meal.

This sounds good to me. I try to stay under 140 2 hours post. I find if I am around 110 or lower post meal I end up in the 40-50 range an hour after that. So 135 is best for me. :top:

[dbaratta]

I am definitely disappointed with anything over 140 EVER, and would be disappointed with a reading of 140 at 2 hours post-meal as well. 140+ is the point at which the glucose in your system causes damage to your organs (or so I have read from multiple sources). I strive for normalcy, not "good for a diabetic."

I agree with this, my point was that we can't be perfect all the time no matter how hard we try. When my numbers are not normal I get mad too, especailly when I have done nothing wrong. I just feel as though some would freak out over a number I wish I had. ;)

[matingara]

But if i eat a good meal and decide to do a check after, and I'm 11 or 12, or even 15, I take a correction perhaps, and move on. I get beat up enough playing hockey, I don't need to do it to myself either......

ah yes! but you have decided to use insulin as a tool. well maybe you have no choice - but it is the main tool at your disposal.

some choose to fight on without insulin - and if they consume a diet that takes their bgls high there is no quick fix and their body, presumably, suffers,,,

[poodlebone]

This is just my opinion but I get the feeling that some people are disappointed in a BG that is around 140 2-hours post meal. I have researched this before but thought I would share the information from the Mayo Clinic on Fasting BG and post meal BG.

Fasting blood glucose targets:
Standard target 80-120 mg/dL (4.4-6.7 mmol/L)
Modified target 100-140 mg/dL (5.6-7.8 mmol/L)
Pregnancy target 60-100 mg/dL (3.3-5.6 mmol/L)

*Individuals with hypoglycemic unawareness (limited or no awareness of low blood glucose symptoms) are in the modified blood glucose target. Your healthcare provider may personalize your blood glucose target for specific medical conditions. Blood glucose targets should be in a healthy range to prevent diabetes complications, but also keep you safe from serious low blood glucoses.



I am hypo unaware and I live alone. After years of having no control (no insurance, as well as being 19 at diagnosis and just not caring) I then tried to get really tight control and ended up being hypo unaware. I started seeing a new CDE 4 years ago and began pumping. She wanted me to set a fairly high BG target (160) to see if I could regain my hypo awareness. I have a really hard time doing that. My brain is still convinced that I will soon become a blind amputee on dialysis if I see a number over 140.

I try to ease up. I know I tend to correct too soon sometimes or to overcorrect, even with insulin on board. Getting a CGMS has helped. My hypos are not nearly as severe as they were on injections. Still, I have a hard time convincing my brain that my numbers don't have to be (and will never be) on a non-diabetic range 24 hours a day. My CDE tells me this all the time. I know she's right. I know I'm not going to die if I set my target higher for awhile. Even with the CGMS hypos can catch me by surprise because I'm not checking it every 5 minutes.

Has anyone else driven themselves crazy trying to perfect and was able to ease up?

[soso]

I am already a bit crazy about it...I seem to have a hard lump in my brain on the subject..I tell myself I am going to just have a meal or two where I don't worry, but that lump won't let me actually do it.. it is like a Pavlov dog..I will actually lose my appetite.
I am trying to work on it by taking slightly less insulin , which puts my after meal numbers up a little , no longer in perfect territory, but no lows either which is one reason I became so burned out i think. And I am only correcting highs when I am certain that they will not come down on their own.

Of course..this is all driving me nuts as well, so not sure how much further ahead I am..lol..
Still, one foot in front of the other.

[xMenace]

That is true as long as it isn't too high. Doc told me better high than low......:eek:

Has your doc ever sat in front of a laser gun and watched his vision being burned up?

I have very low hypoawareness, and my targets are the normal ones. I work hard at ensuring I don't go too low.

[slipperyelm]

For me, one problem is that if I am at 140 two hours post meal, it is quite likely that I will still be near that level when the next meal time comes along. (Type 2, no insulin) Of course that is more likely to happen if it was a large or slowly digested meal and I have to be sedentary after eating.

Another problem is that I know from past experience that when my A1C indicates my average BG is 120 with not much time even above 140 as indicated by daily testing, then I do begin to get neuropathy in my feet. :(

[jillybean]

Well, my thinking is, why strive for normalcy? Guess what? We're not normal. The day we were all diagnosed, we gave up whatever normal card we had in exchange for a diabetic card......

Maybe one reason I think differently than you is that I'm type 2, not type 1, but for me, I strive for normalcy because that is the point at which I can slow the progression/damaging effects of my condition. Why settle for "good for a diabetic" values if those values will cause damage, especially if I have the ability to keep my levels lower than that?

Then, I also know I am very fortunate that I have never had to worry about lows/hypos, so that may very well be another reason for my different thought process. I've ever experienced a low in my life, and I'm not taking anything that could cause a low.

Everyone's individual situation directly affects their individual goals, and no one should be made to feel silly for striving for normalcy. If you can reach normal levels safely, then all the better, right? My last A1C was 5.1, fasting glucose was 80-something, and I was ECSTATIC.

[georgepds]

Maybe one reason I think differently than you is that I'm type 2, not type 1, but for me, I strive for normalcy ....

I'm reading Blood glucose 101 right now. She (the author) notes that neuropathy starts at BG>140 (independant of a1c and/or type 1/2).

Now I realize we all are different, but we are the data indicates we respond to high BG in the same manner

--G

[GeishaGirl]

I tend to really get stuck on the "physical quality of life" (ie, no/few complications" vs the "mental quality of life" (ie, actually living and enjoying your time on this planet). I'm a woman of extremes -- it's salads or ice cream. I either care SO MUCH about my sugars that I wind up in a depressive funk that can last for weeks and, if allowed to get more serious, can become suicidal. Or, I can care so little that I just estimate any carbs, shrug at high numbers, and take some more insulin. And then get depressed and convinced I'm going to lose my feet or my eyesight.

NEITHER ONE IS HEALTHY.

But walking that delicate line between "caring for myself and keeping my sugars as normal as possible" and "enjoying my life, which includes enjoyable food" is really, really difficult for me. I've actually started going crazy because I swing through this pendulum every few days. Two days ago, it was low-carb salads for lunch and chicken breasts for dinner. Today, it's Hot Pockets for breakfast, Raisenets for lunch, and spaghetti and meatballs for dinner. Oddly, my sugars today are BETTER than they were the low-carb day. The only diff is the amount of insulin being used.

I have excellent fasting levels, unless I did something really stupid the night before (went to bed without testing, ate really close to bedtime, etc). My sugar right this second (3 hours post pasta -- and Klondike bar, forgot about that!) is 118 with no correction for highs.

According to my meter, I've tested 54 times in the last 7 days, and my average is 130 -- and I had one day this week where my sugars were in the 300+ range... probably insulin pocket, haven't figured that one out.

Maybe it's just the difference between being a type 1 vs 2. Type 2s understand that carbs raise the sugar X amount, and certain ones should be avoided. I know that, whatever I want to eat, I can take insulin -- but the results are different every day. A bagel for breakfast on Tuesday will leave me at 128 2 hours later, but that bagel on Thursday may spike me to 250. Same time, same amount of butter, etc.

So, I guess the point of this is that.... I give up. I've eaten more **** this week than I have in awhile, and my sugars are actually better (my 30 day average is 157). So why torture myself, at least in this regard?

[jillybean]

I'm reading Blood glucose 101 right now. She (the author) notes that neuropathy starts at BG>140 (independant of a1c and/or type 1/2).

Now I realize we all are different, but we are the data indicates we respond to high BG in the same manner

--G
No, I agree - 140+ is bad regardless of type. But for someone like me who finds it easy to stay under 140 just with diet versus someone else who struggles just to stay out of the 200s, we're going to have different goals because of our differeing circumstances.

[dbaratta]

Has anyone else driven themselves crazy trying to perfect and was able to ease up?[/QUOTE]

This is why I put this post out there. I drive myself crazy also trying to keep things normal. Bottom line, I am not normal. I talked to the doc and told him I wish I could keep my BG constant and normal and he said that is not going to happen. Well, I believe him because it hasn't happened yet and it isn't because I eat poorly. I do it all right,,,,still can't get constant numbers. That is called diabetes. :(

[fgummett]

I do think that the most intuitive approach, for the healthiest physical long-term outcomes, is to aim for as normal BGs as we can BUT that is not to say it is easily or even safely achievable by everyone with D... so we do the best that we reasonably can... we're in this for the rest of out lives, and we need to be kind to ourselves :)

--

Of course that begs the question raised by this thread "what are normal BGs?"...if I may borrow a quote from our resident "Mad Doctor", who I have not seen around here in some time...At a diabetes technology meeting a couple of years ago, some guys from Germany presented some performance data for a continuous (actually every 15 minute) glucose monitor to be worn for three days. In adults with normal glucose metabolism (BMI under 25, fasting glucose under 100, 2 hour glucose on a GTT of under 140), 80 percent of the readings were under 100. That's 20 out of 24 hours. So after meals, the glucose goes up for an hour or two at the most, and then is back under 100 (not 140!). That is PERFECTLY NORMAL (or healthy) glucose.

[jillybean]

Of course that begs the question raised by this thread "what are normal BGs?"...if I may borrow a quote from our resident "Mad Doctor", who I have not seen around here in some time...
I know at the lab where I am participating in a study, the nurse told me that spikes after meals were normal even for non-diabetics, but that they would come right back down to "normal" very quickly, usually even prior to 2 hours after a meal with the highest peak usually seen between 45 minutes and 1 hour post meal. I'll have to ask her what that "normal" is, if they come back down to <140, <120, or <100.