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Why not "normal" BGL's?

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#1
jojeti

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AnCapMan in his previous hospital post said while in the hospital they took him off meds because they felt his bgl's were too low (80's) for a diabetic. This brings up a question I have. A few times in these forums I have seen where doctors say diabetics bgl should be higher than a "normal" person, my question is why? Why do some doctors say that? Any reasoning behind it?
Diagnosed Type 2 April 2010
Lantus 19 units
Metformin 1000 mg 2xday
Lisinipril w HCTZ 20/12.5 mg
Lasix 40 mg 2x day
Levothyroxine 112 mg/day
April 1, 2010, A1c: 7.9 (diagnosis)
June 17, 2010, A1c: 6.1 (c peptide 3.4, bgl 91)
August 5, 2010, A1c: 5.8
February, 2011, A1c: 5.6
August 24, 2011, A1c: 5.3 (c peptide 0.8, bgl 75)
February 17, 2012, A1c: 5.0
Diet: Low carb (< 30 gms a day, but try for less than 20 gms/day)
I am a member of PETA, People Eating Tasty Animals

#2
dturney

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AnCapMan in his previous hospital post said while in the hospital they took him off meds because they felt his bgl's were too low (80's) for a diabetic. This brings up a question I have. A few times in these forums I have seen where doctors say diabetics bgl should be higher than a "normal" person, my question is why? Why do some doctors say that? Any reasoning behind it?


If you inject insulin you keep your BG a little high to avoid Hypo's.:)
:)Diagnosed June 1970
Injecting Insulin since June 6, 1970
42 Years and Counting
Lantus and Humalog
Metformin
I am not young enough to know everything
Modcarb Diet
I eat all the food groups.

:tee:

#3
Tribbles

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If you are on insulin there is an increased risk of hypos associated with lower BG and studies that show increased mortality (thought to be associated with the increase in hypos). I can see no reason why people not on insulin or sulfonylureas should set whatever target they want. That said, below 6.5 there is little change in absolute risk as opposed to percentage change in risk - arguably the benefits aren't worth the sacrifice for some people.

#4
jojeti

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So...I am on Lantus, does that mean I should not go for 80's-90's? I think if someone wants tight control, regardless if they are on insulin, they should be able to do it. It just means more closely watching numbers so you don't get too low.
Diagnosed Type 2 April 2010
Lantus 19 units
Metformin 1000 mg 2xday
Lisinipril w HCTZ 20/12.5 mg
Lasix 40 mg 2x day
Levothyroxine 112 mg/day
April 1, 2010, A1c: 7.9 (diagnosis)
June 17, 2010, A1c: 6.1 (c peptide 3.4, bgl 91)
August 5, 2010, A1c: 5.8
February, 2011, A1c: 5.6
August 24, 2011, A1c: 5.3 (c peptide 0.8, bgl 75)
February 17, 2012, A1c: 5.0
Diet: Low carb (< 30 gms a day, but try for less than 20 gms/day)
I am a member of PETA, People Eating Tasty Animals

#5
foxl

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I was waking in the early 80's and even 70's so I decreased my Levemir (since I lowered my carbs). I was not feeling low, but worried what might be happening in my sleep. Only my wakeup number changed.

I also was worried my Endo would say my A1c was too low, and would take me off the Lev altogether ...
Linda


[B]Jan A1c 6.3/B]
Jul 09 ... C-pep 1.3, GAD-65 > 30
Mar 10 C-pep 2.8 (20 g carb); GAD 3.2
dx 02/09 in DKA


Levemir 12U per day; novolog PRN TDD ca 16U
MetforminXR 1000 mg BID
Ramipril 5 mg
T4 112 mcg
Chia oil
Vitamin D3, 4000 IU
Eating 20 - 45 g carb per day ovo-lacto-vegetarian
Walking 30 min 6x week

#6
jenb

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I also was worried my Endo would say my A1c was too low, and would take me off the Lev altogether ...


What a Catch-22. Your BG level is within a wonderful range with the Levemir and it's possible that the doctor will eliminate the Levemir, then your BG will rise, then you can have the Levemir, then the number will fall, then you can't have the Levemir...

If the meds are working they should be left in place (IMHO).

Jojeti - when I was in the hospital in DKA, the nurses told me I should never let myself go below 90 and I was terrified when I did the first week out. The one good thing I got from my former Endo was that 70's rock! If the occasion arises I will definitely fight with any medico who tells me that living within "normal" range is too low.

Jen

#7
foxl

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Jen -- this is not anything anyone said ... just my irrational fear after 14 mos without insulin, that it will be taken away! :)

I am perhaps a bit nuts, after this medical experience (well, okay, and before it).
Linda


[B]Jan A1c 6.3/B]
Jul 09 ... C-pep 1.3, GAD-65 > 30
Mar 10 C-pep 2.8 (20 g carb); GAD 3.2
dx 02/09 in DKA


Levemir 12U per day; novolog PRN TDD ca 16U
MetforminXR 1000 mg BID
Ramipril 5 mg
T4 112 mcg
Chia oil
Vitamin D3, 4000 IU
Eating 20 - 45 g carb per day ovo-lacto-vegetarian
Walking 30 min 6x week

#8
ShottleBop

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So...I am on Lantus, does that mean I should not go for 80's-90's? I think if someone wants tight control, regardless if they are on insulin, they should be able to do it. It just means more closely watching numbers so you don't get too low.


Yes. It can be done.
Functionally, a Type 2 (missed the label by th-a-a-a-a-t much)
Dx prediabetic 02/08 (FBG 127 and 123), A1c 6.5
So far, controlled without meds.

#9
Jillzd

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So if you're not on insulin, why do they tell you that your numbers should be higher than non-diabetics?

#10
jojeti

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Jen -- this is not anything anyone said ... just my irrational fear after 14 mos without insulin, that it will be taken away! :)

I am perhaps a bit nuts, after this medical experience (well, okay, and before it).


LOL...I think you and I are a lot a like! I too am fearful that by gaining tight control my insulin will be taken away!
Diagnosed Type 2 April 2010
Lantus 19 units
Metformin 1000 mg 2xday
Lisinipril w HCTZ 20/12.5 mg
Lasix 40 mg 2x day
Levothyroxine 112 mg/day
April 1, 2010, A1c: 7.9 (diagnosis)
June 17, 2010, A1c: 6.1 (c peptide 3.4, bgl 91)
August 5, 2010, A1c: 5.8
February, 2011, A1c: 5.6
August 24, 2011, A1c: 5.3 (c peptide 0.8, bgl 75)
February 17, 2012, A1c: 5.0
Diet: Low carb (< 30 gms a day, but try for less than 20 gms/day)
I am a member of PETA, People Eating Tasty Animals

#11
fgummett

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I'd suggest the risk of hypos with injected insulin is tied to how well your BGs are controlled. Not everyone can manage this safely (for many different reasons) but if you can achieve stable BG control, I don't see why aiming for lower/normal BGs puts you at any greater risk of hypos than someone with widely swinging BGs who is aiming for an higher average.

#12
fgummett

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It makes sense to me that we could all be aiming for normal BG levels (same as someone who does not have Diabetes) IF normal BG levels can be safely and reasonably achieved -- without frequent hypos, or spending every waking hour as a slave to Diabetes control.

I find it a bizarre concept that some feel those of us with Diabetes have a different BG scale than those without Diabetes.

We are treated to a stricter standard than the general population when it comes to Blood Pressure (BP) or cholesterol/lipid levels, yet are allowed (even expected) to sail along with higher than normal BGs... which is especially crazy when you consider that higher BG levels can contribute to higher BP and deranged lipid levels.

Again, not all of us can achieve normal BG levels all the time but I prefer to have that as the place I ideally aim for, rather than an arbitrarily high level.

#13
jojeti

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I'd suggest the risk of hypos with injected insulin is tied to how well your BGs are controlled. Not everyone can manage this safely (for many different reasons) but if you can achieve stable BG control, I don't see why aiming for lower/normal BGs puts you at any greater risk of hypos than someone with widely swinging BGs who is aiming for an higher average.


Medical people must not give much credit to diabetics in general. It seems they just assume that diabetics are not able to tightly and safely control their BGL and base all their treatments on these assumptions.
Diagnosed Type 2 April 2010
Lantus 19 units
Metformin 1000 mg 2xday
Lisinipril w HCTZ 20/12.5 mg
Lasix 40 mg 2x day
Levothyroxine 112 mg/day
April 1, 2010, A1c: 7.9 (diagnosis)
June 17, 2010, A1c: 6.1 (c peptide 3.4, bgl 91)
August 5, 2010, A1c: 5.8
February, 2011, A1c: 5.6
August 24, 2011, A1c: 5.3 (c peptide 0.8, bgl 75)
February 17, 2012, A1c: 5.0
Diet: Low carb (< 30 gms a day, but try for less than 20 gms/day)
I am a member of PETA, People Eating Tasty Animals

#14
biggleton

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hi, im a 16 yr old t1 from England,

my doctor says the target range is 4-7mmol/l, which equates to 72-126 mg/dl (pre-meal) i think your doctors must not respect your judgement enough to allow you to aim for normal bgl values.

#15
ShottleBop

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Medical people must not give much credit to diabetics in general. It seems they just assume that diabetics are not able to tightly and safely control their BGL and base all their treatments on these assumptions.


Before home-use glucose monitors made MDI practicable, hypos were much more of a threat. Using fixed doses of insulin and requiring people to "cover their insulin", instead of bolusing to cover their carbs, made it much more difficult to control matters. Application of Dr. Bernstein's low-carb approach, based on the Laws of Small Numbers, also helps avoid hypos (by reducing the effects of the myriad variables that affect insulin dosing, absorption, etc., and of miscalculations)--but with his full-on Type 1s, even Dr. Bernstein has them shoot for 90, instead of 83.
Functionally, a Type 2 (missed the label by th-a-a-a-a-t much)
Dx prediabetic 02/08 (FBG 127 and 123), A1c 6.5
So far, controlled without meds.

#16
jps

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I believe that if it is at all possible, we should aim for the numbers normal people get. I realize that isn't possible for all T2's, but for some, it is.

I understand a physician's reluctance when a patient is on insulin, however. The risk of hypos is real and dangerous. That being said, it is possible to maintain tight control and "normal" numbers even when on insulin, but it does require a very active approach.
"That which doesn't kill us makes us stronger" - Friedrich Nietzsche

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#17
jojeti

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hi, im a 16 yr old t1 from England,

my doctor says the target range is 4-7mmol/l, which equates to 72-126 mg/dl (pre-meal) i think your doctors must not respect your judgement enough to allow you to aim for normal bgl values.


I don't agree, my doctor trusts me and has never said that to me but I think in general, most medical people base their treatments on assumptions rather than looking at the individual. They are doing what they are told to do for this disease.
Diagnosed Type 2 April 2010
Lantus 19 units
Metformin 1000 mg 2xday
Lisinipril w HCTZ 20/12.5 mg
Lasix 40 mg 2x day
Levothyroxine 112 mg/day
April 1, 2010, A1c: 7.9 (diagnosis)
June 17, 2010, A1c: 6.1 (c peptide 3.4, bgl 91)
August 5, 2010, A1c: 5.8
February, 2011, A1c: 5.6
August 24, 2011, A1c: 5.3 (c peptide 0.8, bgl 75)
February 17, 2012, A1c: 5.0
Diet: Low carb (< 30 gms a day, but try for less than 20 gms/day)
I am a member of PETA, People Eating Tasty Animals

#18
fgummett

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There is also unfortunately the legal side of things where a Doctor may feel protected by advising to shoot for higher BGs -- these may lead to long term complications at some time in the future when they cannot be easily tied to the Doctor's advice, while lower BGs may be seen to cause acute, short-term risk through hypos :(

I choose to aim for what I am convinced is the best for me... not for my Doctor.

#19
suhr

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I think most doctors don't really KNOW their patients. Some of you may have been seeing your doctor for years (decades? :D ) but consider the average patient. Doctor sees them a few times a year for 30 minutes at a time.

Given that, it is not surprising to me that Doctors don't "trust" their patients to be careful enough with their BG levels to recommend the 80s. It is much safer to recommend slightly higher levels.

If the average patient is anything like my parents and grandparents, I'm afraid I agree. We at DF are in the tiny, tiny minority of people who geniunely strive to normalize our BG levels. I think the vast majority of diabetics are much more lax and shoot for "close enough" if they even try for that. In those cases, someone in the 80s is "close enough" to a potential hypo to worry docs.
Shayne
36 year old male :cool:
Diagnosed 02/01/2010
02/01/10 > FBS 141, A1c 6.3, Cholesterol 297, Trigs 448 :eek:
04/30/10 > FBS 85, A1c 5.6, Cholesterol 159, Trigs 109 :D :D :D
10/20/10 > FBS 86, A1c 5.1, Cholesterol 175, Trigs 111 :cool:
04/21/11 > FBS 86, A1c 5.2, Cholesterol 190, Trigs 168 :argh:
10/17/11 > FBS 88, A1c 5.5, Cholesterol 195, Trigs 131

#20
fgummett

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While I understand what you are saying, I don't think it is really good enough to pander to the lowest common denominator... in my experience if you approach people with low expectations you are unlikely to be disappointed :T but if you challenge expectations you may be surprised to find out how many people will rise to that challenge.

I agree that the folks here on DF are in the minority but what makes us different..? Are we somehow especially motivated, or is it perhaps that we have simply become aware that there are different approaches than the standard (low standard) one trotted out by too many heath care providers? I suspect it is some from column A but also some from column B.

---

If you went to a lawyer to represent you in court and she/he did a poor job because she/he didn't really know you... would that be acceptable to you? It is one thing to recognise that many Doctors may be rushed/overworked etc... and as such end up providing a low standard of care, but it is quite another thing to accept it as normal and not seek to improve the situation.




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