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Saturday, August 01, 2015

Blood Glucose Targets 2015

Several years ago I investigated the different targets suggested by three major respected US diabetes authorities. As a result I wrote this: Blood Glucose Targets. My 2006 summary included this comparison table:











Over the years those have changed very little. The 2015 comparison noting significant changes in bold is:











Sources: ADA, Joslin, AACE.

The ADA and Joslin now agree on the looser 2hr post-prandial target of 180(10) and both have also lowered the threshold for fasting. The AACE guidelines are unchanged. If you read the details on the linked pages all add caveats concerning relaxation of targets in case of other medical conditions, age etc.

Thirteen years after diagnosis, thankfully still free of complications, I see no reason to significantly change my closing remarks originally written nearly ten years ago.

The AACE advise much tighter post-prandial targets. I doubt that anyone would consider the American Association of Clinical Endocrinologists, a professional community of several thousand physicians specializing in endocrinology, diabetes, and metabolism as a bunch of fanatical radicals. Nor would they be promulgating guidelines impossible to be attained by the majority.

Unfortunately, nobody but pro-active type 2 diabetics talks much about 1hr PP targets. My personal logic is that I treat their 2hr as my recommended max peak for any post-prandial, as I discussed in When To Test? Those AACE guidelines then agree very closely with Jennifer's Test, Test, Test advice. Make your own judgment on which of those guidelines you think will lead to fewer complications.

Sadly, it appears that only 1/3 of senior diabetics are achieving even the loose ADA targets, but that is a discussion for another topic.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

10 comments:

Anonymous said...

I guess I need to read more of your blog that I just found because your comment here has got me lost. I was diagnosed with t2d around 4 years ago. Managed it pretty good with a change in diet and exercise. Then I had one issue after another and couldn't exercise for about six months. The weight came back and the a1c skyrocketed from 5.9 to 7.9. I started taking metformin a week ago. Really uncomfortable with the bloating and diarrhea. Blah. I read that some people take Imodium but I wonder if that does any good for the gays bloating? Do you have any ideas sir?

Anonymous said...

I guess I need to read more of your blog that I just found because your comment here has got me lost. I was diagnosed with t2d around 4 years ago. Managed it pretty good with a change in diet and exercise. Then I had one issue after another and couldn't exercise for about six months. The weight came back and the a1c skyrocketed from 5.9 to 7.9. I started taking metformin a week ago. Really uncomfortable with the bloating and diarrhea. Blah. I read that some people take Imodium but I wonder if that does any good for the gays bloating? Do you have any ideas sir?

Alan said...

Try beginning again with this post: http://loraldiabetes.blogspot.com.au/2006/10/d-day.html

Let me know how you go.

Cheers, Alan

ANN SMITH said...

Hello Alan,
With all the talk lately about "pre-diabetes" I've noticed there has been some talk about post prandial testing. I wish I couldn't remember where I read it but no doubt the site was reputable. I was in healthcare for 15 yrs. But that site stated that pre-diabetics need to do the 2h pp while the DM2s should test 1.5h pp. I'm sure you're familiar with the GTT testing done years ago to diagnose diabetes. A shorter version is done still today with gestational diabetes. For the reader, a quick explanation.fasting blood taken, then drink a cup of coke syrup. Wait an hour, then test every hour for 3 hours. That's an awful long day at the lab when you're 15 like I was back in the 60s. Never knew the results. Anyway, the thinking back then was everybody's BG goes up after a meal but it's how fast it comes down is what determines if you're a diabetic or not. Now we have the A1c, but I'm not so sure if an occasional GTT wouldn't be helpful in a diabetics treatment. Hope this gets posted. Good day Alan!

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Barbara said...

Hi Alan,

It's been awhile since I've been on your site -- and I've not been good about watching my diet -- not as much as when I first started reading you about three years ago. However, with my AlC at 5.9 and my fasting blood readings around 105 to 110, I am quite concerned and back on the wagon.

I'm changing doctors, as I feel he is very unconcerned about my readings, and I would like to start on Metformin, at least to see if I can tolerate it. It's so inexpensive and safe, that I'd like to try it. A Harvard study recently suggested it as a means of keeping pre-diabetics from going into full diabetes.

Besides my sad story, I do have a question however, what is your opinion of steel cut oatmeal 1/2 cup for morning breakfast? With half and half milk -- no carbs. Some claims say it helps lower glycemic index and is good for diabetics. Do you agree? I'm tired of my one egg for breakfast and need some variety.

You can also email me if you prefer: barbarasiry@gmail.com

Alan said...

G'day Barbara.

My opinion of that breakfast does not matter. Your meter's 'opinion' an hour after breakfast is the one to take notice of.

To be honest, I would not be starting metformin with your excellent A1c. However, that's just my opnion. If you decide to add metformin start at a low dose (500mg or 850mg once daily with a meal) and watch for gastric side effects. If there are none increase to the doctor's recommended full dose gradually, to minimise the chance of side effects. It would be wise to discuss both the need for the med and that ramping up process with your doctor.

Alan said...

Barbara, read this for a little more variety to start your day: http://loraldiabetes.blogspot.com.au/2006/10/breakfasts.html

Barbara said...

Hi Alan,

Will do -- and thanks so much for your quick response and your valued opinion about metformin and the possible effects of oatmeal for breakfast. I'll take a look at breakfast varieties -- that's my dullest meal, and I used to enjoy it so, when I could eat cold cereal and toast with jam.