5.1 is ridiculous as a diagnostic A1C. If someone is consistently having really high post-meal spikes with a normal A1C that *might be cause for concern but otherwise I can’t imagine why people would be worried about that.
I can’t remember offhand, but can check. I remember the nurse calling to tell me I had failed, and when I asked the number she said, “oh, you didn’t fail by that much, let me see here…oh, wait, that was the other patient i was calling, your number was a lot higher.” then when we saw a high risk doc, he asked what my number was hoping I’d been borderline, and he congratulated me on my failure.
This exactly. Things settled down some post delivery, but I’ve continued to have a range (hormone-dependent) of 1:6-1:10. It took a couple of visits with my ob before my doctor would believe that I was even trying to control my bgs. I stayed under 100 carbs most days, but was afraid to go much lower while carrying a baby (still no good idea of what the ideal carb range is for a baby’s developing brain). His threshhold was 120 at the 1 hr mark, and I do credit that with helping me keep much tighter control moving forward.
Interestingly my worst fasting number (135) was post-delivery.
Interesting… I wonder if the standards are tighter for failure for pg women.
That seems crazy to me. That’s far tighter control than many nondiabetic blood sugar.
They are.
ETA: but the postprandial ranges vary doctor by doctor, of course. I don’t find a rec of 120 an hour out to be all that crazy. As i recall, my GTT failure was around 180, but for some reason that test is not showing up online, so I can’t be sure of the number. I do remember using the number as leverage with my doctor to avoid taking (and failing) a 3 hour test. I was already taking insulin at that point, so I saw no reason to go through that. My doctor agreed that it was of little consequence, since the failure had been definitive.
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Yeah might as well shoot for the stars if you’re already taking insulin… I can’t possibly keep my 1 hour under 120 no matter how carefully I dose or what I eat and I’m still considered super tightly controlled-- I don’t lose too much sleep over it though because a typical non diabetic is higher than that at 1 hour
http://www.diabetes-symposium.org/index.php?menu=view&id=322
Kinda long to listen to since it’s an audio but it seems to indicate that “normal” may actually more erratic than the conventional wisdom which is nicely summarized in this article:
It is interesting to me that many diabetics are actually targeting a tighter blood sugar range than nature gives Non-diabetics… it will be interesting to see if it actually proves beneficial
They really are. What I heard most commonly from my doctors and other pregnant diabetics was <140 at 1hr, <120 at 2hrs, and <95 fasting. I did hear a few who had the <120 at 1hr, but I’m glad my doctors didn’t tell me that, because I would have been (even more) stressed trying to keep under that. Pregnancy carries a lot more risks if your blood sugars aren’t well controlled.
Wow! My range is now 1:25-1:35 depending on time of day, so things have calmed down significantly for me.
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This is the new standard for pregnant women, because of evidence that even slightly elevated blood sugar (at least in the OGTT) is linked to some small increase in risk of adverse outcomes for women (BTW, there’s no evidence that controlling these women who are at a “subclinical” level actually improves outccomes yet). I think the problem is that doctors are extrapolating from failures on the OGTT to what is an acceptable level day to day. I.e. I’m very skeptical that one or two readings above 120 would cause women to have pregnancy complications – but at the same time, if you’re failing the OGTT it’s probably likely you’re having many many high BG events on the standard American diet. I’m not sure if expecting women to always stay below 120 makes much sense.
I find it interesting, too. This (relatively recent?) drive to flatline puzzles me, to be honest. Why do many diabetics strive to achieve something that is totally abnormal in non-diabetics? Less of a spike is good, therefore no rise at all is best? It will be interesting to see whether it’s a beneficial approach, but I suspect it’ll be a while before we know.
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It’d be decades before any meaningful conclusions could be drawn and would require long term studies of cgm data and mortality would have to be organized and maintained for many years…
The whole subject is surrounded by misinformation-- many diabetics actually think that non diabetics blood sugar doesn’t increase when they eat— Bernstein has even made the absurd claim that non diabetics blood sugar is always exactly 83 all the time regardless of what they eat and of course he has many believers…
Perhaps someday all type 1 diabetics will significantly outlive the general population.
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Not to mention, it’s the standard so that a baby has a better shot at full-term birth and avoiding respiratory distress syndrome upon delivery. Or being LGA (large for gestational age), which leads to other concerns with delivery. Additionally, stable blood sugars mean more stable blood control in the baby after delivery, fewer hypoglycemic incidents after birth, and less NICU time (if any).
I agree, it’s a standard that is difficult to maintain and a line that could risk further hypo episodes (don’t even get me started on why pregnant mothers, often without any prior insulin experience, don’t have short-term access to cgms…or ANY training whatsoever)! Still, it’s a target, and I don’t think it’s a particularly bad one.
Back to the original question, it seems that if a patient has a creeping A1C even while maintaining a lower-carb diet and exercise, the possibility of diabetes ought to be on the practitioner and patient’s radar and not dismissed out of hand. Perhaps good doctors listen to patients who come saying, “something is changing about my body’s ability to process carbohydrates, and it concerns me.” More often than not, however, concerns fall flat.
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I think that this is a good illustration of the all too common disconnect between the doctors perspective and the patients’… I think most doctors would see it as “we did respond to their concern by evaluating their a1c-- which was normal and we’ll check it again next year to see if it’s still normal” not to mention that expensive antibody testing is likely not covered by insurance for people who don’t have a diagnostic code of diabetes-- so if doctors routinely order labs like that and their patients get stuck with the bill that doesn’t make them happy either-- its kind of a damned if you do damned if you don’t situation for them…
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I didn’t read his book. I am still making my way through Ponder’s book. But the “83 claim” doesn’t even make sense. Could he have meant average or reasonable target or something like that? It is obvious that everybody’s BG is not 83 so he HAD to have meant something else?
No he pretty much said unequivocally that all non diabetics’ blood sugar is exactly 83 all the time and then went on to elaborate that diabetics’ should be too but they should give themselves a little cushion and instead shoot for exactly 90 all the time… if I recall correctly
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This one drives me nuts. Bernstein has a lot of good things to say but he speaks with a lot of what I think is hyperbole to drive his point home. People then tend to take his word as gospel.
When I test people who are healthy I usually see something closer to 90 (5.0 mmol/l)… but anyway…
Q: Now how on earth did I get such an odd ball number like 83?
A: I got it because we used to be located on a major thoroughfare, and we had a sign outside that said DIABETES CENTER. All of the meter salesmen would stop by and demonstrate their meters. I would say, “I have had enough finger sticks today. It’s your turn.”
So we would stick their fingers, and what would we get? It was amazing. People in their twenties and thirties all were around 83. So I said, “That must be what a normal blood sugar looks like.” Since that time, I have looked at the epidemiologic studies. It looks like the minimum point for mortality and heart disease is around 83. So, those above and below 83 have higher relative risks of overall mortality. It looks like what I originally learned by chance is pretty close to the cut-off point that the epidemiologic studies show.
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I’m no fan of Bernstein, and he may have said that elsewhere, but in The Diabetes Solution, 4th ed. (the one I can quickly find online), what he says is:
The nondiabetic ordinarily maintains blood sugar immaculately within a narrow range – usually between 70 and 95 mg/dl, with most people hovering near 83 mg/dl. There are times when that range can briefly stretch up or down – as high as 160 mg/dl and as low as 65 – but generally, for the nondiabetic, such swings are rare.
Which, incidentally, I think is a dangerous and exceedingly unscientific blanket statement.
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Yes. There is a lot in Bernstein’s book that I agree with, but I am of the opinion that some statements, like the one you quoted, are made by Bernstein to scare patients into submission as opposed to presenting scientific facts.
There are a lot of scientific studies out now which strap CGMs to non-diabetic patients that provide a lot more interesting data.
Here is one I like which is a bit more rigourous:
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Also made to sell books
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Good point… 
I’ve been entertaining myself reading this thread.
A couple of years ago I had an in office A1c at an endo appointment. To my chagrin it said it was 6.3. My doc noted my displeasure and told me it was great! He wished that his A1c was that good (he was not diabetic) and that normal non diabetic is up to 6.4.
He never discouraged me from being sub 6 but said it was not necessary to be that low. And this guy was not some moron endo. He was the founding director of the Texas Diabetes Institute at UTSA, widely respected and published, and Dr. Defronzo’s best friend.
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