Blood glucose

[gwix98]

Recent changes in "normal ranges" for fasting serum glucose levels have
made a significant number of boomers and others fall into the
"pre diabetes" catagory.

For instance the lab for which I work now has moved the upper limit for
a fasting glucose to 99 mg/dl. Several years ago it was 110, and 20 years
ago when I started my career it was 125.
This puts a significant number of people into this classification.

I now fall in this range. I am curious as to what others on this board
are doing to control blood sugar levels besides exercise, diet or traditional
oral hypoglycemics such as Metformin. Particularly interested in those
having success with natural products like cinnamin.

Diabetes is a huge problem in this country, and growing.

Rich..any ideas comments?

[windsurf]

I was shocked when I recorded a 124 fasting glucose. Earlier in life, it had been below 100 but decades of eating refined flour porducts, tons of cereal, bread, pizza, pasta and potatoes took a toll in resulting insulin resistance (another name for pre-diabetes and, then, adult on-set, type II). I was heavy into sports drinks and energy bars which typically have a load of sugar that also assaults the insulin receptors of your cells. I bought a glucometer so I could check it peridically without an MD visit. I reduced refined food carbs and avoid anything with sugar (occasional desserts at a birthday or something) and it has come down. Genetics can play a role here as my wife never recorded the levels I had. On the other hand, she never ate the quantitities of the crap that I had. Diet is absolutely a culprit here but it takes will power to resolve to get your carbs from whole foods. Most of what I eat comes from the perimeter of the grocery store.

[rs0460a]

Since I've "managed my condition" since being diagnosed 5 years ago, I attribute my "success" primarly to three things:

- Diet (control those carbs!)
- Exercise (helps keep glucose down)
- Stress reduction (you would be surprised how stress impacts glucose!)

- Ron

[Rich_in_Tampa]

There have been changes in the old 1997 criteria, as follows:

* Normal — Fasting plasma glucose<100 mg/dL (used to be <110 mg/dL)

* Impaired fasting glucose (IFG) — Fasting glucose between 100 and 125 mg/dL

* Diabetes mellitus — fasting at or above 126 mg/dL, or a two-hour post-glucose load at or above 200 mg/dL (11.1 mmol/L), or a random (or "casual") plasma glucose concentration greater than or equal to 200 mg/dL in the presence of symptoms.

What's less clear is whether IFG really represents a risk factor for the usual targets of diabetes damage. It looks like high glucoses in response to eating are a bit more accurate as predictors of cardiac events, survival, etc. At the very least, if you have IFG it is time to really embrace the diet and exercise thing.

Another issue is that abdominal fat cells have been found to be pretty active, almost like an endocrine organ. They cause resistance to insulin and lots of other bad things. Lose them and you make good headway in risk reduction, even if you total body weight or BMI is not that high.

For me, that abdominal girth is the last thing that goes when I lose weight - it really doesn't want to go and I have to push to the limit to lose it in waist circumference.

[windsurf]

Rich_in_Tampa's point about waist girth and the activity of those fat cells is interesting. Consequent of my cutting refined carbs was, of course, weight loss and a couple of inches off the waist.

[gwix98]

Well it has really become interesting to me.
Having been involved in lab values for over 20 years to see
significant changes in the glucose range. Most other chemistry
analytes have ranges that have been pretty stable

The Hemoglobin A1C range for our lab has not changed in
20 years. Interestingly mine is the same as it was 20 years ago when
my typical fasing glucose was in the 85-95 range, about 5.1%.

Lets hope the IFG turns out to not be a strong indicator for the usual targets
of diabetes damage. I'm not holding my breath..time to get serious about this stuff.

[Rich_in_Tampa]

Originally Posted by gwix98

The Hemoglobin A1C range for our lab has not changed in
20 years. Interestingly mine is the same as it was 20 years ago when
my typical fasing glucose was in the 85-95 range, about 5.1%.

Well, that one is under close scrutiny now, too. It looks like the HgbA1C level does correlate with risk fairly well but when you get down below the mid-5's, the risk is low enough that it's hard to distinguish from the general population risk, i.e. if there is any correlation at all, it's almost too little to detect. Get well up in the 6's and you start to see some correlation.

Bottom line has not changed: get fit, get skinny if you have risks.

[FIRE'd@51]

Originally Posted by gwix98

Most other chemistry analytes have ranges that have been pretty stable

The "normal" cholesterol levels (total and LDL) have been reduced significantly, I believe.

[Rich_in_Tampa]

Originally Posted by FIRE'd@51

The "normal" cholesterol levels (total and LDL) have been reduced significantly, I believe.

Just to be clear, it is not the laboratory techniques or the general population that changed, but rather it is recognition that risk increases at lower levels than realized, so a previously "normal" cholesterol of 300 is now known to represent significant risk. The level at which to get concerned has thus been lowered, rather than a technical or statistical adjustment.

In these cases is it not so much about bell-shaped curves or 2 standard deviations from the mean, but rather the clinical outcome implications of specific values, even if 30% the population is considered "abnormal" as a result. I think this is reasonable, since we would otherwise keep raising the normal range as we grow increasingly obese in the false impression that the new normal range is just fine.

[gwix98]

Originally Posted by Rich_in_Tampa

Just to be clear, it is not the laboratory techniques or the general population that changed, but rather it is recognition that risk increases at lower levels than realized, so a previously "normal" cholesterol of 300 is now known to represent significant risk. The level at which to get concerned has thus been lowered, rather than a technical or statistical adjustment.

In these cases is it not so much about bell-shaped curves or 2 standard deviations from the mean, but rather the clinical outcome implications of specific values, even if 30% the population is considered "abnormal" as a result. I think this is reasonable, since we would otherwise keep raising the normal range as we grow increasingly obese in the false impression that the new normal range is just fine.

Yes, I forgot about total cholesterol. We have reduced our ranges for that.


Interestingly regarding age and normal ranges, I was having a talk with our medical
director/pathologist recently regarding PSA's. I believe we still report one range for men regardless of age. I think there is the feeling that more age dependent "normals"
for PSA's may eventually be used. Maybe the guy who is 46 and has a PSA of say 3.5 may be at
more risk than the guy who is 85 and has a 3.5.

Rich, you are an internist right? Whats been your experience with patients in the
IFG range (100-125) demonstrating any diabetes related complications, such as
peripheral neuropathies, early kidney disease (elevated creats),etc?

[LOL!]

The beauty of a lower recommended range for blood glucose, is that your doc can get a "Hgb-A1c" test done on your blood. That can help "know who you are."

OTOH, if you get the answer you don't want, does that create a pre-existing condition for future health insurance?

[Rich_in_Tampa]

Originally Posted by gwix98

Rich, you are an internist right? Whats been your experience with patients in the
IFG range (100-125) demonstrating any diabetes related complications, such as
peripheral neuropathies, early kidney disease (elevated creats),etc?

Any one physician's experience in a question like this is irrelevant since it takes thousands of people over several years to detect a statistically important difference. So I try to monitor the large cohort trials to stay abreast of what this all means. So far, it seems rare to see an excess of such complications in the IFG group according to most studies.

[spideyrdpd]

Hi Gwix
As you probaly know from your experience some how many people live as undiagnosed diabetics. So lowering the numbers will hopefully make people aware earlier. Many people have been diagnosed because they already have complications or the constant waking in the nite to pee.
As far as your risk you have to look at the entire picture. Diet, stress, weight, cholesterol, blood pressure and family history as well as your blood glucose numbers.
They also are or should be very aggressive with the cholesterol and the blood pressure.
Rob

[Mountain_Mike]

I think it is the cynic in me, but "normal" blood glucose levels may have been adjusted downward at the behest of the pharmaceutical corporations as a way of creating more clients. But then, maybe not.

[FIRE'd@51]

Originally Posted by Mountain_Mike

I think it is the cynic in me, but "normal" blood glucose levels may have been adjusted downward at the behest of the pharmaceutical corporations as a way of creating more clients. But then, maybe not.

Oh, I don't think this is the case at all. From what I have read, a substantial number of endocrinologists believe that by the time the fasting numbers reach 126, there has probably been substantial loss of pancreatic beta cells due to years of high post-prandial (after meals) glucose toxicity. Many recommend an oral glucose tolerance test for those in the pre-diabetic (100-125) range, especially if there is a family history of diabetes. Apparently, you can have normal fasting readings even with diabetic levels of glucose after meals.

[rs0460a]

Originally Posted by FIRE'd@51

From what I have read, a substantial number of endocrinologists believe that by the time the fasting numbers reach 126, there has probably been substantial loss of pancreatic beta cells due to years of high post-prandial (after meals) glucose toxicity.

After I was diagnosed (2001), I took the diabetes management class at a local hospital. They mentioned a statistic that you are diabetic (or a "diabetic in process") for up to 10 years before your levels are at the point of being diagnosed.

Also, in reference to the comment about the drug company, I (like many others) manage it with diet/exercise. Someday I'm sure I will take meds, but it's been 5 years and still have A1C's in the 5.x's.

- Ron