Attention Diabetics: I have a question

[Kalhoun]

Okay...let it be known that I'm not asking for medical advice. I'm just looking for your experienced opinions.

1. What number does your doctor say is a "good" number for your blood sugar?
2. What number causes you concern?
3. What number causes you alarm?

If you want to throw your age and sex in here, that would be helpful as well. Thanks to all who participate! Oh. Also, are you type I or II?

[BobLibDem]

1. Much depends on when you test. Before meals between 90-110

2. I would get concerned if consistently results were > 150

3. Over 200 with no apparent reason

Type 2

[Beware of Doug]

38; male; Type 2. It's been recommended that I keep the morning fasting BG ? 110. I am concerned if it's over 140 then or before dinner, and alarmed if it's over 200 at any time.

Just saw Diabetes Guy today and I am definitely in that "concern" category. My fasting BG, slowly creeping up after 2 years of good control, is now consistently hovering around 150 and today's A1c read 7.2 (we want it ? 7.0 and ideally ?6.0).

I'm currently on metformin (1500mg/day). It worked a little better when it was the extended release type, so we're going back to that. DG also wrote me a scrip for Actos, which supposedly boosts insulin uptake. Has anybody any experience with Actos?

[Beware of Doug]

?s = "< or = to" signs.

[cerberus]

Current Guidelines for Tight Control

Rapid Testing:

Fasting(Not Eaten in > 8 Hours): <100 mg glucose / dL serum
Post-Prandial(After Eating): <140 mg glucose / dL serum after one hour; <120 mg glucose / dL serum after one hour

A1C Testing: Measures load of sugar-bonded red blood cells: expressed as % of total red cells. Best goal is to maintain 4% tp 6% A1C. Some sources use <7% for DM patients.

Also, consider blood pressure, BMI, serum lipids and urinary protein.

[Beware of Doug]

Post-Prandial(After Eating): <140 mg glucose / dL serum after one hour; <120 mg glucose / dL serum after one hourShould it be <120mg/dl after two hours? (You say one hour twice.)

[Miss Purl McKnittington]

1. 70-120, unless it's right after a meal and then it can be higher. I'm most comfortable when it's in the mid-80s.

2. If it's hovering around 175-200 and I'm not stressed out or sick.

3. Above 170 for no reason, especially if it was normal the last time I checked.

21, f, Type I

This is all mg/dL, btw. My last A1c was 7.0 and I got hollered at. I'm supposed to be down to 6.0 by the spring. If it's not, I'll have to give up my insulin glargine/insulin aspart combo and go back to regular/NPH, and that means no more flexible mealtimes. Dammit.

[cerberus]

Yes ... PPG should be <120 mg/dL after two hours ...

It is important to monitor things besides sugar. A number of things cause problems in Type 2 DM: hyperglycemia(too much serum glucose), hyperlipidemia(too much serum cholesterol) and hyperinsulemia(too much serum insulin)...

[Kalhoun]

It sounds like you would all be "alarmed" if you tested around 225 after fasting for three weeks running, huh?

[Lynn Bodoni]

It sounds like you would all be "alarmed" if you tested around 225 after fasting for three weeks running, huh? That is in the "see the doctor within two days" category for me. I'm 48, female, and I take insulin, though I developed diabetes as an adult.

[Kalhoun]

That is in the "see the doctor within two days" category for me. I'm 48, female, and I take insulin, though I developed diabetes as an adult.
My dad was diagnosed as "borderline" years ago. They gave him a diet that would control the blood sugar and cholesterol, and it worked. This is how he's tested at the doctor's office over the last three weeks. The doctor is sending him a diet in the mail. He is not on "glypicide" or whatever that booster pill is, and he's not on insulin. They gave him a testing kit. Does this sound like the reaction your doctor would have?

[irishgirl]

You would all HATE our endocrine team here.

We use different figures of measurement (mmol/L not mg/dL), but basically the aim is physiological glucose measurements i.e. below the threshold needed to be diagnosed as diabetic.

Which means:
Blood glucose of between 4-6mmol/L
HbA1C of less than 6%
BP of 120/80
A BMI of less than 25
Fasting lipids at the lower end of normal.

Anyone who isn't achieving that gets medicated and exercised until they do, so most patients with type 2 diabetes are on 4 or more medications, a calorie controlled low fat, salt and sugar diet and 2 hours of aerobic exercise a week.

The rate of complications has fallen dramatically since they've brought that protocol in, but the patients are less than thrilled.

[Kalhoun]

He exercises daily. He's a mall-walker and does like 30 minutes a day at a fast clip. He's 76, drinks 4-6 shots of whiskey/day (which I understand by itself doesn't affect blood sugar) and enjoys sweets. However, he's been very good, diet-wise during this testing period so he'd have good numbers and not have to go on medication. My initial feeling, based on information on line from the American Diabetes Assn. and other opinions, is that this time the problem cannot be controlled by diet. Maybe I'm wrong...

[irishgirl]

Alcohol may affect blood glucose, and it can certainly affect blood pressure- hypertension is one of the important risk factors for cardiovascular events.

If at all possible, can you get him to cut down on the whiskey?

[Kalhoun]

From this site: http://www.diabetes.org/type-1-diabetes/alcohol.jsp

The American Diabetes Association suggests that you have no more than two drinks a day if you are a man and no more than one drink a day if you are a woman. This recommendation is the same for people without diabetes.

Yes, I believe he will cut out the daily cocktail (he adds a bit of ginger ale to his whiskey, which I think is the bigger problem with diabetes). He won't cut it out altogether unless he absolutely had to, but I believe he'll willingly cut his consumption in at least half.

[Angua]

Okay...let it be known that I'm not asking for medical advice. I'm just looking for your experienced opinions.

1. What number does your doctor say is a "good" number for your blood sugar?
2. What number causes you concern?
3. What number causes you alarm?

If you want to throw your age and sex in here, that would be helpful as well. Thanks to all who participate! Oh. Also, are you type I or II?

I'm in the UK, and use the same units that Irishgirl's talking about, but I'll convert my numbers.

1. Between 4 and 7 mmol/l (72 to 126mg/dl)
2. If my sugars drop below 3.5mmol/l (63mg/dl) or get above 9mmol/dl (162mg/dl). However, I'm having issues with my meds at the moment, mainly because it would appear that my pancreas is giving up the ghost.
3. Anything above 13.0mmol/l (234mg/dl) really gets me worried. However, its never got that high.

My main problem is that I end up going hypo in the middle of the night, which causes my fasting levels to be too high. However, since my results during the day are pretty tightly controlled, its not as much of a problem as it could have been.

[Kalhoun]

Do you all test throughout the day or is it a once in the morning kind of thing usually?

[Kalhoun]

Do you all test throughout the day or is it a once in the morning kind of thing usually? Oh. And another question...do you manage your diabetes via a GP or do most diabetics see a "specialist" (endocrinologist???)?

[Kalhoun]

:smack:

[VunderBob]

1) 90<BG<150 is good

2) BG<90 or BG>180

3) BG<60 or BG>220

Male, 44, Type II, diagnosed about 10 years now. I also had an RNY gastric bypass in June, and I've lost 75 lbs so far. I stopped Actos cold turkey, I'm weaning myself off glipizide at the moment, and I haven't touched the Metformin at all.

I also try to test twice a day, usually as I get up, and either right after work, or just before bed. In practice, I'm lucky to get in 1 test a day.

Primary management is by primary physician, but I've recently started seeing an endocrinologist also.

[Angua]

Do you all test throughout the day or is it a once in the morning kind of thing usually? Oh. And another question...do you manage your diabetes via a GP or do most diabetics see a "specialist" (endocrinologist???)?

I test throughout the day. Because its my morning blood sugars that are an issue, those get checked everyday. I tend to test randomly at other times in the day, or when I'm feeling particularly ill.

[Lips_Obsession]

I've been diagnosed as Type II for about 2.5 yrs. Lately, my morning readings have been on the high side (135 - 150), while late afternoon numbers have been more in the range my MD suggested (below 120).

I also have slow digestion. (I forget the medical term for it, but they gave me a test one time where I ate radioactive food and while a normal person would have digested the food given in 90 min, my stomach took 300+ min to digest.) I'm wondering what kind of effect this slow digestion would have on BG numbers after eating. I always see people talking about readings 1-2 hours after you eat. Wouldn't my numbers be different than most because of the digestion issues?

I've asked my MD about this, and never gotten a satisfactory answer. I'm going to a diabetes fair in early November and hope to ask about it then as well.

BTW, I'm on metformin for now. Started out at 500mg of the XR about 2 months ago, increased to 750mg about 3 weeks back. Still some uncertainty if that's what I'll stick with as I have some sort of bumps that they sent me to a skin doctor about and they took a biopsy, said it could be due to new meds. That's the only new med I've added in the last 2 yrs.

[Ethilrist]

My answers are going to differ in type from other peoples' because I've been working with some specialists at the International Diabetes center.

1. What number does your doctor say is a "good" number for your blood sugar?

Within 100 points of the last time I tested.

2. What number causes you concern?

More than 100 points over where it was the last time I tested. Or below 90, because I'm going to be having an insulin reaction soon.

3. What number causes you alarm?

HIGH. Or below 60, which means I'm freaking out and looking to eat a sackful of cookies.

The theory is, since i'm using Humalog before each meal and Lantus at night, the Humalog governs my blood sugars 2 hrs after eating, and the Lantus governs my blood sugars before the meal. I'm not looking to keep the numbers in lockstep range, 80-120, because they're going to vary some throughout the day, which is normal, so if I happen to check when it's higher, I shouldn't freak out. I'm just looking to be below a certain number before I eat, and back to that general ballpark a couple hours later once the Humalog has done its thing; if it's a little high, the Lantus will cause it to drop before the next meal.

This gets adjusted some if I'm more than 200; I take an extra unit of Humalog for every 50 points above 150, and adjust the number I'm looking to see accordingly the next time I test.

For example, if I'm at 200 when I eat lunch, normally I'd take 8 units of Humalog. Instead, I take 9 units, to cancel out the extra 50, and then I'm hoping my blood sugar is around 150 2 hours later. If it's still 200, then I probably ate too much. By dinnertime, it should be down to 150.

[The Vorlon]

Doug--I had good results with Actos, and I say HAD because BCBS of MA got their underware bound up by something. They put me on Advantia, then doubled the dosage, and it still does nothing. 12 hour fast numbers average 150, and that is makeing my eyebrows go up.

Methinks the MD and I will be talking tomorrow. He will not be happy or ammused.

[Kalhoun]

Doug--I had good results with Actos, and I say HAD because BCBS of MA got their underware bound up by something. They put me on Advantia, then doubled the dosage, and it still does nothing. 12 hour fast numbers average 150, and that is makeing my eyebrows go up.

Methinks the MD and I will be talking tomorrow. He will not be happy or ammused.
Your insurer can make the calls on your meds? HOW CAN THAT BE??? That's very scary!

[VunderBob]

Your insurer can make the calls on your meds? HOW CAN THAT BE??? That's very scary!
If the drug isn't on the insurance company's formulary, tough shit. They won't pay for it.

[Kalhoun]

If the drug isn't on the insurance company's formulary, tough shit. They won't pay for it.
Is this a drug you cannot afford on your own? If so, that really blows.

[VunderBob]

Is this a drug you cannot afford on your own? If so, that really blows.
Actos is quite pricey. That's why I was heartbroken when I stopped taking it after my bypass.

[Kalhoun]

Well, daft ol' geezer that he is, my dad said that he had his cholesterol number mixed up with his blood glucose number. His glucose is 110. A far cry from the trauma numbers he gave me yesterday! Needs to work on that cholesterol, but he is bringing it down little by little.

Thanks all for your input. It was interesting and informative. I appreciate it!

[The Vorlon]

Your insurer can make the calls on your meds? HOW CAN THAT BE??? That's very scary!



The scary part is both Actos and the sugar pills they switched me to are within $20 of each other---that was they were, when I was on the lowest dose of the new, useless pill. The double dose I'm on now does nothing more than cost double what the pill that works costs.

Now if I get the medium dose of Actos and split the pill, it winds up being a quarter the cost of the useless drugs.

BCBS is staffed by living brain donors.