American Diabetes Association (ADA) guidelines advise “lowering A1C to below or around 7%” and postprandial (after-meal) glucose levels to 180 mg/dl or below. But new research shows that these glucose levels damage blood vessels, nerves, organs, and beta cells.
An article by diabetes blogger Jenny Ruhl analyzes at what blood glucose level organ damage starts. According to Ruhl, research shows that glucose can do harm at much lower levels than doctors had thought.
This news could be discouraging or even terrifying. If it’s hard to meet your current glucose goals, how will you reach tighter goals? Such news might make some people give up. But remember, a high postprandial or fasting reading won’t kill you. All we know is that higher numbers correlate with higher chances of complications. You have time to react.
In fact, we could choose to look at this as good news. We all know of people who developed complications despite “good control.” But complications are not inevitable; it’s just that so-called “good control” wasn’t really all that good.
First, the numbers. “Post-meal blood sugars of 140 mg/dl [milligrams per deciliter] and higher, and fasting blood sugars over 100 mg/dl [can] cause permanent organ damage and cause diabetes to progress,” Ruhl writes.
For nerve damage, University of Utah researchers studied people with painful sensory neuropathy, or nerve damage. They found that participants who did not have diabetes but who had impaired glucose tolerance on an oral glucose tolerance test, or OGTT, (meaning that their glucose levels rose to between 140 mg/dl and 200 mg/dl in response to drinking a glucose-rich drink) were much more likely to have a diabetic form of neuropathy than those with lower blood glucose levels.
The higher these OGTT numbers go, the more nerve damage is found, according to Johns Hopkins Hospital researchers. The OGTT gives a good idea of how high after-meal blood glucose levels are likely to be.
Glucose can also start killing beta cells at levels below 140. One study found that people with fasting blood glucose from 110–125 (within the official “prediabetic” range) had already lost up to 40% of their beta cell mass.
Italian researchers found that even with glucose levels in the supposedly “normal” range, beta cells started to fail. Ruhl says that researchers “found that with every small increase in the 2-hour glucose tolerance test result, there was a corresponding increase in…beta cell failure. The higher a person’s blood sugar rose within ‘normal’ range, the more beta cells were failing.”
Failing beta cells will lead to worsening diabetes, a truly vicious cycle. Slightly elevated glucose has also been shown to cause eye damage (“retinopathy”) and increased rates of heart disease, kidney damage, and stroke.
Where Does High Start?
Studies like the ones Ruhl quotes and others indicate that damage occurs with even slightly elevated blood glucose. But what can you do about that? Is it reasonable to try to keep glucose at normal levels all the time?
It seems for some people, that course would lead to frustration and burnout. In fact, ADA says that older, sicker people should have even less strict goals. How do you set reasonable goals for yourself?
Keeping normal numbers may require extraordinary effort. It may require very low carbohydrate intake. It may not be possible for you. If you’re taking insulin or drugs in the sulfonylurea or meglitinide classes, aiming too low can put you at risk of hypoglycemia (low blood glucose). The whole thing can make you crazy, because sometimes numbers will go up for no apparent reason.
As a result, most people set less-demanding goals for themselves. If they can keep their postprandial glucose under 180 and their fasting below 120, they’re OK, and the ADA agrees.
There’s nothing wrong with that. People can trade off how low they want their blood glucose against how much work they are willing to do and how many foods they’re willing to cut back or give up. They are adding to their risk, but, to me, quality of life is the most important thing.
Important note: Bringing blood glucose down by means of multiple drugs has NOT been shown to decrease complications much. Two huge studies, the ACCORD and ADVANCE trials showed this.
But people who manage to keep normal or near-normal numbers through healthy eating and living and intelligent use of medicines seem to live long, relatively healthy lives. They can even reverse type 2 or the complications of Type 1, even if they have spent years with elevated blood glucose before getting them under control. It’s almost never too late to get on track.
So my question is what are your target numbers? How high is too high for you? Does it make sense to aim for normal, non-diabetic levels, or is that just too demanding and unrealistic? If you had a newly diagnosed friend or relative, what would you tell him or her about glucose goals?
David: All I can relate to is my direct experience about how high is high. I have great discomfort about those folks arguing for numbers and averages that meet out of the factory brand new body working 110 per cent fine.
Foer 30 years, I was all over, bad and rotting out. In last 5 years, my data shows that:
once BG gets to 155 ( 6.9) and under - 6.4; the following happened:
a) eyes cleaned up and no more hemorages on the retinas. Preciously bad.
b) weight dropped, and need for large amounts of insulin boost dropped signifigantly.
c) kidneys now stable and in good shape for a number of years and was on a 3 month watch upgraded to one a year.
d) off the dam actos.
As we are not steam engines that can go in for a complete rebuild periodically; our chemical plant ages and gets sloppy anad thus control is looser - wider swings and lower lows and liver grief. I do not see how we really get a older person back to the same numbers and swing of those numbers of a younger person and plant.
Fingerprick caveman tools of 20% accuracy and 1 week unstable gronky cgms sensors technology are not sufficient to provide the window and control to run an older plant as if brand new.
We still are in a search for the holy grail in medicine for the single vampire killing silver bullit - wooden stake rather than a a combined tuning stratagy of multiple hormones and meds; diet and exercise to fine tuning the body.
We simply are not there yet.
I truly wish folks promoting tigher numbers for diabetics whould have a more balanced open view of all the issues and not just use bossterism to push on things of questionable practical merit.
Yes, this is an analog world and the larger the magnification, yes we can see all new worlds and issues but can we really absorb that now. The numbers on type 2 diabetics increase indicates we can barely get folks under 7.0 a1c never mind 5.0.
Posted by jim snell | Sep 13, 2012 at 12:16 pmIf 140 mg/dL or less at all times is necessary then high fat and low carb diets are a in the least highly desirable for diabetics and those on their way to diabetes. Also Diane Fennell’s article about high HDL being desirable supports that. I found in my case that eating a high fat diet including saturated fats(with the exception of trans-fats) improves HDL quite a bit without affecting LDL that much. Funny that the official doctrine is the opposite of this in spite of mounting evidence to the contrary.
Posted by calgarydiabetic | Sep 13, 2012 at 4:48 pmcalgarydiabetic adds more excellent valid comment.
The fat in diet slows the digestion race as well and keeps spikes down.
I agree.
Posted by jim snell | Sep 14, 2012 at 10:34 amOne of my many diagnosed problems is Generalized Anxiety Disorder. Stress elevates my mg/dl close to 400, especially extreme stress. My daughter recently had surgery for cancer and my wife has been staying with her to help with the children. I didn’t feel like making a pot of coffee for one person so I used instant. The only instant we had was decaf. My morning finger-prick test dropped from 370 to 155! this has been holding true for almost a week now. It seems caffeine is one of my enemies. To hell with coffee!
Posted by Steve Speare | Sep 19, 2012 at 1:02 pmI put in my vote to keep peak readings below 140 (7.8).
Only a low carb. diet makes it easy enough to do (for me) and keep your blood sugar close to looking like a person without diabetes. The nice thing about this is that you can pretty much forget about fat intake (other than trans fat of course). You sort of live your life a couple hours at a time but you get very used to this (well most of the time :)
It’s been several years since I started this approach and weight stays normal and complications (years in the making) have pretty much disappeared.
(A1c from over 12 to just over 5)
Did find it is important to know what your body is and how you need to approach your treatment… something too many doctors just don’t get — they seem to like the one size fits all approach.
Posted by JohnC | Sep 19, 2012 at 1:07 pmAny insight on how to control early morning near normal (86) or low reading (62)at 3am and then 7 am reading at 149. Any hints on how to control this from happening?
Posted by DanE | Sep 19, 2012 at 2:44 pmIn response to DanE, what you are seeing is generally called “dawn phenomenon” and it is the result of the release of Cortisol at about 3 am. For me, it causes my blood sugar to rise between 6 am and 10 am. After that, it remains stable. But also in my case, even if I don’t eat a single bite, my blood sugar will rise from 80-90 to over 300 in those 4 hours. Obviously, I take insulin (I’m type 1) but my mother, who had Type 2, had the same problem. The analogs (Novalog and/or Humalog) work too fast to cover this, but a small dose of R works fairly well at preventing the blood sugar from rising. Discuss with your PCP.
Posted by Lori Hamlin | Sep 19, 2012 at 4:20 pmHere’s my take on the whole BS (Blood Sugar) reading thing. If I maintain a decent food intake and exercise regularly, I really don’t care what my daily or even weekly ups and downs are. Sure, I’ll continue to test each day, but really the A1C pretty much tells the story. It is based on what’s been happening over a three month period. I have experienced the terror that the medical profession puts into the hearts and minds of diabetics, and the resulting discouragement that ensues, when they implore people to worry over their blood sugars readings several times a day. I believe that this is left over from concerns with Type I diabetics or insulin dependent Type II diabetics who really don’t have enough or any insulin and therefore have to adjust insulin to match carb intake and other things.
I know that if I overeat, I’m likely going to have a high BS reading. Likewise, if I snack a lot at night, my morning BS is going to be higher than my average BS. So what?! It’s like saying that every breath you take or every glass of water may contain some carcinogenic substance. Yeah, we know that isn’t good, but should we stop breathing or stop drinking water? Some people get bent-out-of-shape about the particulars. Life is too short to waste so much time worrying about minutia. The answer is not to get all excited but to continually return to the moderate, balanced, lifestyle.
I think that getting to and staying at 7.0 is a reasonable goal–for me. If I had my way, I’d drop most of the hair splitting experiments that deal with BS values. The article above shows clearly one thing. To be alive means that some sort of cell is going to die on a regular basis. Do we really have to nit-pick about a couple of decimal points on a A1C or a couple of points on a glucose reading. I personally, think not!!!!
Posted by John Bell | Sep 19, 2012 at 6:32 pmI got interested on response from Lori. What is R?
Posted by H Rios | Sep 19, 2012 at 8:31 pmThanks
IN LORI HAMLIN’S REMARKS, SHE STATED THAT ” A SMALL DOSE OF R WORKS FAIRLY WELL AT PREVENTING THE BLOOD SUGAR FROM RISING”. WHAT IS R?
Posted by FRANK | Sep 19, 2012 at 9:16 pm“R” refers to “regular” insulin. This used to be the fastest acting kind, but now the analog insulins work much faster — too fast according to Lori.
Posted by David Spero RN | Sep 20, 2012 at 10:22 amI like John Bell’s response. Diabetes controls us every day and to not think about it all the time is great. I feel the doctors are trying to make more people diabetic with scare tactics. My husband’s now ex-doctor harped at him all the time - he is not diabetic - to the point when he went for his physical, the doctor only went on and on about diabetes and didn’t bother to do the physical so he knows nothing about the important things you find out from a good physical. Not the necessary blood tests and bodily tests. He gets a D- rating as a doctor.
Posted by Ferne | Sep 21, 2012 at 10:45 amI don’t know what i am suppose to do. Before I had M.V.A., my level was between 140 &v190. After my wreck it shot up to between 200 & 290. I was left a paraplegic and now am developing full blown C.R.P.S., and my levels are in the 300dredsl Sometimes in the 400 levels. Once it was 598. I take metformin, a shot in the belly every morning of some kind of long acting insulin, and finger pricks and shots four times a day. And my levels are still out of sight. I read about how you body crumbles and folds every time your levels get out of the norm, but i don’t know what to do about it. I am in a nursing home and have nurses handling my meds and the kitchen handles my meals. I don’t snack between meals. My doctor is a good doctor, but doesn’t act over concerned about this aspect of my medical problems. WHY is my type 2 out of control???? I am in constant pain from the crps, but can not go to a pain specialist. I am so afraid of the crps getting out of control and going beyond the point of possible remission. Any way, I didn’t mean to bother you guys. I apologise.
Posted by Donald Roberts | Sep 21, 2012 at 10:30 pmIn reference to the article on ‘How high is too high!’ I read an article in a publication, of which, I can’t remember the name, that BS for some people can be higher than the traditional guidelines and not be a negative for the individual. I believe is arelated to the size of a person, ie weight, age, etc. My BS usually run in the 180-240 range and my AiC is 8.5. I know it is still high on the charts, but is there any evidence that the article is correct?
Posted by Larry | Sep 23, 2012 at 9:06 amA good friend of mine is haveing extremely high level, she exercises eat a fairly good diet and takes meds but is still having high readings. What can she do to bring these down?
Posted by Michelle | Feb 07, 2013 at 11:28 amI am suffering through the same issue as DanE. (I am Type 1.) Sugar before sleeping in the night is fine. I even take ‘bed-night’ insulin - Mixtard 30 (earlier it was Mixtard 50) and if I wake up after 8-hrs, inevitably it’s high. If it’s 6-hrs, then it’s fine; means that I better take my morning dose of insulin quickly.
I was under the impression that Mixtard has a 10-12 hr cycle. Besides it seems weird that when there’s no exercise (while sleeping) the absorption is fast. Or…it’s the ‘Dawn Phenomenon’ at work?
I was following 180 as the PP level to aim for. 140 - boy, that’s going to be a tough one :-)
So…what’s the max level for fasting - not 120?
Posted by Anuj | Mar 04, 2013 at 11:27 pmI have had diabetes now for almost 11yrs. i got it when i was pregnant with my son and never went away. i am now almost 47 yrs old. i am very hard on myself when comes to eating. i am only 137pds. not overweight at all(can afford to loose maybe 10) but never the less lately my blood sugars are high when i dont even eat bad things. the last test when i was at the doctor my Aic was 6.3 i know when i go in april it will be higher. why is this happening and especially when i didnt even eat high carbs or desserts. does your body change every 7yrs have anything to do with your insides changing in results to do with diabetes. please if you have any input let me know thanks signed frustrated diabetic
Posted by michele | Mar 18, 2013 at 6:37 pmMichele, please ask your doctor if there might be some medical reason for your higher numbers, like an infection. Are you under some major stress? Also, are you getting your usual amount of activity?
I have heard that you can make yourself crazy trying to keep numbers in the normal range. It might be better to have an A1c of 8.5% than to spend every waking minute worrying about what you ate and what your BS is now. However, if you can find a fairly simple, not too invasive way to get your numbers down, I think it’s worth it. This usually seems to be a low-carb way, although other diets have worked for some people.
Posted by David Spero RN | Mar 19, 2013 at 2:16 pmI was soooooo happy to read the post by John Bell! I have been diagnosed a type 2 diabetic 3 years ago and I worry constantly, every minute of every day about my numbers. The stress has made me a different oerson then i was. i used to be fun and have a great sense of humor, now all i do is cry and worry! I have been doing research from books and on the Internet and listening to different doctors, not to mention numerous dietitians……..ugh! They all contradict each other. I recently decided to do what John has done. I’m sick of this ruling my life! I will continue to exercise and eat as healthy as I can…..maybe splurge a little bit on special occasions. We are all going to die some day of something. If I die because of diabetes……..then so be it!
Posted by Tricia Vandemark | Apr 05, 2013 at 3:46 pmThank You John!
I’ve seen enough diabetics with amputations and missing eyes to take the “diabetes be damned!” attitude. If you don’t take care of your b.g. levels, parts of your body will start dying off. Some of the doctors out there are very ignorant of diabetes. My initial A1C was over 11. I’m getting ready to get my A1C in a couple of days. I’d be shocked if my number is not under 6.5. Despite only 3 months past my initial diagnosis, my low carb diet(30-50 grams/day) has kept me consistently below 140. I’ve even stopped taking Glyburide because it was causing too low b.g. levels at night. I’d recommend people ask their doctors to see an endocrinologist for further help to get their b.g. under control. My doc has very little faith that people can control their b.g. level thru diet and exercise. It doesn’t have to be a struggle. Yeah…it sucks I can’t overeat on desserts any more but…such is my new reality. Best wishes to everyone.
Posted by Mark N. | Apr 30, 2013 at 1:08 pmGOSH WHERE DO I START? I HAVE BEEN D2 SINCE 2009. I HAVE NEVER HAD A NORMAL READING TIL I STARTED INSULIN 6 WEEKS AGO. WITHIN THESE YRS (2009-PRESENT) I HAVE GAINED AND LOST WT. FROM 135-210. RITE NOW I AM ON THE UP-ROAD TO WT. GAIN. WHEN I STARTED INSULIN I STARTED AT 10 UNITS, 30 DAYS I WAS UP TO 20. NOW I HAVE SWOLLEN FEET & LEGS FROM PRAVASTATIN. MY FEET & LEGS GO UP AND DOWN. INSULIN NOW AT 30 UNITS.
Posted by MARY P, COLORADO | May 11, 2013 at 4:45 pmI THINK THAT DIABETES IS AN ISSUE THAT SHOULD BE TREATED LIKE AN ADDICTION TO DRUGS OR ALCOHOL AND IN THE DIABETIC LIVES OF MANY BAD FOOD IS OUR ENEMY JUS LIKE DRUGS ARE TO A DRUG ADDICT AND ALCOHOLIC. THEREFORE, WE SHOULD HAVE OR SHOULD I SAY I WOULD LIKE TO HAVE A PLACE WHERE I CAN GO FOR REHAB FOR A FEW MONTHS JUS LIKE AN ALCOHOLIC OR DRUG ADDICT HAS TO GO FOR REHAB. WILL IT WORK? I THINK YES FOR ME IT WOULD.
I KNOW THIS SOUNDS CRAZY BUT I/WE COULD DIE TOO. AND IT AINT SAFE FOR US TO BE DRIVING A CAR OR USING MACHINES WHEN OUR SUGARS ARE HIGH.
IF I HAD THE MONEY TO BUILD OR MAKE/START A REHAB FOR DIABETICS THAT JUS CAN NOT GET A HANDLE ON THIS LIKE MYSELF I WOULD DO IT ASAP.
PLEASE CAN SOME ONE GIVE ME FEED BACK ON THIS…
I WOULD BE SO GREATFUL TO HEAR OTHERS OPINION.
THANKS, MARY P.
I just began testing my blood in the mornings. I am Type 2, on Metformin once a day (500 mg) and my very first fasting test the number was 160. I have no idea if that is dangerously high or not. The nurse told me about low blood sugar levels, but not how to handle high ones. Also what is this Dawn Effect or Dawn Phenomenon and how do I handle it? I’m not a big eater and usually do not eat after 9:00 pm.
Posted by Carol | May 13, 2013 at 3:57 pmMary in Colorado — I don’t think there are any such retreat camps, at least not any that ordinary people could afford. Please try to find a diabetes support group in your area. If your doctor’s office doesn’t know of one, search online for “diabetes support groups Colorado.” Also, see my article, “Can Type 2 Diabetes Be Reversed“?
Carol, you can get answers about the dawn phenomenon on our site by using the search function. A fasting glucose level of 160 is too high, but not “dangerously high” in the short term. You have time to fix this.
You are also on a very low metformin dose. Ask your doctor about taking another tab at night.
Posted by David Spero RN | May 14, 2013 at 1:12 pmI have been diagnosed as a type 2 diabetic and am taking 1000mg of metformin before breakfast and dinner. Testing upon rising I am averaging 112 - 125 and 2 hrs after each meal, I have been averaging 110 - 140. Are these numbers high for someone taking 1000mg of metformin twice a day?
Posted by Pat | May 17, 2013 at 3:43 pmMy dr just told me I am borderline diabetic, with a fasting glucose level of 100. I checked it again this morning before eating and it was 125. I am 38, weigh 138. I have not been sleeping well the last couple of months, maybe 4-5 hours per night, and am always wide awake at 3 am. Been busy and stressed and a bit of anxiety creeping in.
Is 120 a high fasting level? I read on another sight that sometimes your levels can spike over night causing your body to become alert and making sleep difficult. Any suggestions? Am I just over thinking this?
Thanks
Posted by Mandy | May 18, 2013 at 10:54 amI am a type 1 diabetic and have been grossly unman-aged for about 6 years. I recently started taking care of myself and keeping my sugar under 200. But this morning I took 20 Lantus which is normal and 15 novolog to cover my high of 271 and breakfast, which was small bowl of Oatmeal with a handful of raisins and cinnamon. 2 hours later it rose to 302 and I wanted to exercise but I can’t due to my glucose levels. What should I do to lower it so I can continue to exercise? They say not to if its over 250.I’m a 5′9″ 200 Lbs.
Posted by Christopher Sevillano | May 18, 2013 at 3:37 pmPat and Mandy,
Both of you have glucose numbers in the prediabetic range. There are a number of things you can do to bring them down. My favorites are exercise, vinegar, bitter melon, and cinnamon. Eating very little refined carbohydrate will also help.
Christopher, your numbers are too high. I would talk with your doctor or a diabetes educator, or read more to find out how to bring them down. Exercise whenever you get the chance. You might want to change your diet — probably with less carbs.
Posted by David Spero RN | May 20, 2013 at 1:39 pm